Cognitive Decline May Signal Future Heart Disease, Study Finds

A long-term study suggests that a noticeable acceleration in cognitive decline can occur years before a person is diagnosed with cardiovascular disease (CVD). The research, published in JAMA Network Open, indicates that changes in mental processing speed may be detectable up to eight years before a cardiovascular event.

Individuals who developed CVD showed faster cognitive decline across multiple domains compared to matched controls, with changes appearing several years before diagnosis.

Study Design and Participants

Researchers analyzed 11 years of data from the Aspirin in Reducing Events in the Elderly (ASPREE) trial and its extension, ASPREE-XT. The study included 19,114 participants aged 70 and older (65+ for U.S. racial/ethnic minorities) who had no prior CVD at enrollment. Participants were from the United States and Australia, with follow-up continuing through December 2022.

During a median follow-up of 8.7 years, 1,934 incident CVD events were recorded. Each participant who developed CVD was matched with a control participant based on age, sex, and education level for comparison.

Measuring Cognitive Function

Cognitive performance was tracked using standardized tests:

• Modified Mini-Mental State Examination (3MS): Assessed global cognition.
• Symbol Digit Modalities Test (SDMT): Measured processing speed.
• Controlled Oral Word Association Test (COWAT): Evaluated verbal fluency.
• Hopkins Verbal Learning Test–Revised (HVLT-R): Tested episodic memory.

Key Findings on Timing of Decline

The analysis revealed a clear pattern of accelerating cognitive decline in those who later experienced a CVD event:

• Processing speed decline was detectable up to 8 years before CVD onset.
• Episodic memory and global cognition changes appeared approximately 5 years before onset.
• Verbal fluency changes became evident about 3 years before onset.
• Composite measures of executive function and global cognition showed accelerated decline beginning roughly 6 years prior.

Patterns were consistent across most CVD subtypes—including stroke, heart failure, and fatal coronary heart disease—but were less pronounced for nonfatal myocardial infarction.

Results Across Subgroups

Sex-stratified and subgroup analyses (by diabetes, chronic kidney disease, and hypertension status) showed similar patterns of pre-CVD cognitive decline. The researchers noted:

• Some steeper trajectories of decline in females.
• Slightly larger effect sizes in participants with chronic conditions like diabetes or hypertension.

Implications for Healthcare

The researchers propose that accelerated cognitive decline may reflect shared vascular and neurological processes that occur well before an overt cardiovascular event. They suggest that incorporating routine cognitive assessments into preventive care could help identify high-risk individuals, though establishing meaningful clinical thresholds for decline requires further research.

Limitations and Future Directions

The study did not directly test the underlying biological mechanisms linking cognitive decline to CVD. The authors note that future research should include more diverse populations and integrate biomarker-based measures of subclinical vascular disease to better understand these associations.