AF Tied to 45% Increase in Mild Cognitive Impairment
TOPLINE:
Atrial fibrillation (AF) is associated with a 45% increased risk of mild cognitive impairment (MCI), an outcome that’s linked to cardiovascular risk factors and multi-comorbidity, results of a new study suggest.
METHODOLOGY:
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From over 4.3 million people in the UK primary electronic health record (EHR) database, researchers identified 233,833 (5.4%) with AF (mean age, 74.2 years) and randomly selected one age- and sex-matched control person without AF for each AF case patient.
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The primary outcome was incidence of mild cognitive impairment (MCI).
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The authors adjusted for age, sex, year at study entry, socioeconomic status, smoking, and a number of comorbid conditions.
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During a median of 5.3 years of follow-up, there were 4269 incident MCI cases among both AF and non-AF patients.
TAKEAWAY:
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Individuals with AF had a higher risk of MCI than those without AF (adjusted hazard ratio [aHR], 1.45; 95% CI, 1.35 – 1.56).
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Besides AF, older age (risk ratio [RR], 1.08) and history of depression (RR, 1.44) were associated with greater risk of MCI, as were female sex, greater socioeconomic deprivation, stroke, and multimorbidity, including, for example, diabetes, hypercholesterolemia, and peripheral artery disease (all P < .001).
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Individuals with AF who received oral anticoagulants or amiodarone were not at increased risk of MCI, as was the case for those treated with digoxin.
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Individuals with AF and MCI were at greater risk of dementia (aHR, 1.25; 95% CI, 1.09 – 1.42). Sex, smoking, chronic kidney disease, and multi-comorbidity were among factors linked to elevated dementia risk.
IN PRACTICE:
The findings emphasize the association of multi-comorbidity and cardiovascular risk factors with development of MCI and progression to dementia in AF patients, the authors write. They note that the data suggest combining anticoagulation and symptom and comorbidity management may prevent cognitive deterioration.
SOURCE:
The study was conducted by Sheng-Chia Chung, PhD, Institute of Health informatics Research, University College London, UK, and colleagues. It was published online October 25, 2023 as a research letter in the Journal of the American College of Cardiology (JACC): Advances.
LIMITATIONS:
The EHR dataset may have lacked granularity and detail, and some risk factors or comorbidities may not have been measured. While those with AF receiving digoxin or amiodarone treatment had no higher risk of MCI than their non-AF peers, the study’s observational design and very wide confidence intervals for these subgroups prevent making solid inferences about causality or a potential protective role of these drugs.
DISCLOSURES:
Chung is supported by the National Institute of Health and Care Research (NIHR) Author Rui Providencia, MD, PhD, of the Institute of Health informatics Research, University College London, is supported by the University College London British Heart Foundation and NIHR. All other authors report no relevant conflicts of interest.
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