Association of cardiovascular diseases with cognitive performance in older adults.

BACKGROUND: Cognitive function and cardiovascular disease (CVD) have a bidirectional relationship, but studies on the impact of CVD subtypes and aging spectrum have been scarce. METHODS: We assessed older adults aged ≥60 years from the 2011 to 2012 and 2013 to 2014 cycles of the National Health and Nutrition Examination Survey who had coronary heart disease, angina, prior myocardial infarction, congestive heart failure, or prior stroke. We compared CERAD-IR, CERAD-DR, Animal Fluency test, and DSST scores to assess cognitive performance in older adults with and without CVD. RESULTS: We included 3,131 older adults, representing 55,479,673 older adults at the national level. Older adults with CVD had lower CERAD-IR (mean difference 1.8, 95% CI 1.4-2.1, P < .001), CERAD-DR (mean difference 0.8, 95% CI 0.6-1.0, P < .001), Animal Fluency test (mean difference 2.1, 95% CI 1.6-2.6, P < .001), and DSST (mean difference 9.5, 95% CI 8.0-10.9, P < .001) scores compared with those without CVD. After adjustment, no difference in CERAD-IR, CERAD-DR, and Animal Fluency test scores was observed, but DSST scores were lower in older adults with CVD (adjusted mean difference 2.9, 95% CI 1.1-4.7, P = .001). Across CVD subtypes, individuals with congestive heart failure had lower performance on the DSST score. The oldest-old cohort of patients ≥80 years old with CVD had lower performance than those without CVD on both the DSST and Animal Fluency test. CONCLUSION: Older adults with CVD had lower cognitive performance as measured than those free of CVD, driven by pronounced differences among those with CHF and those ≥80 years old with CVD.

Long-term clinical outcomes according to the mean observed blood pressure in patients with coronary artery disease after drug-eluting stent implantation.

BACKGROUND: A recent guideline emphasized strict blood pressure (BP) control for the patients at high risk for cardiovascular events. However, there are little data about the relationship between BP control and clinical outcome in Korea. We sought to evaluate the clinical outcomes according to the mean observed BP in patients with coronary artery disease (CAD) who had undergone drug-eluting stent (DES) implantation. METHODS: We reviewed records of 1010 CAD patients with DES from 2010 through 2011. After excluding in-hospital mortality cases (n = 79), we categorized patients into two groups based on the average SBP (SBP) at the outpatient clinic: mean SBP 120 mmHg or less (n = 290) and mean SBP greater than 120 mmHg (n = 641). Primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction, repeat target vessel revascularization, or stroke. Propensity score matching was performed to adjust for differences in baseline clinical variables. Median follow-up duration was 77.7 (36.6-87.3) months. RESULTS: The mean SBP greater than 120 mmHg had higher prevalence of cardiovascular risk factors, such as diabetes (38.4 vs. 27.2%, P = 0.001), hypertension (58.8 vs. 32.4%, P < 0.001), and chronic kidney disease (3.3 vs. 1.0%, P = 0.043) than mean SBP 120 mmHg or less. MACCE incidence was significantly lower in the mean SBP 120 mmHg or less than in the mean SBP greater than 120 mmHg (14.3 vs. 22.0%, P = 0.007) at 77.7 months. Even after propensity score matching, the mean SBP 120 mmHg or less showed significantly reduced MACCE rate (14.3 vs. 22.8%, P = 0.007). CONCLUSION: Mean observed SBP 120 mmHg or less was associated with a lower incidence of future adverse outcomes in CAD patients with DES.