The relationship of coronary artery calcium and clinical coronary artery disease with cognitive function : a systematic review and meta-analysis

Xia, Congying; Vonder, Marleen; Sidorenkov, Grigory; Oudkerk, Matthijs; de Groot, Jan Cees; van der Harst, Pim; de Bock, Geertruida H; De Deyn, Peter Paul; Vliegenthart, Rozemarijin

doi:10.5551/JAT.52928

Title

The relationship of coronary artery calcium and clinical coronary artery disease with cognitive function : a systematic review and meta-analysis

Author

Xia, Congying

Vonder, Marleen

Sidorenkov, Grigory

Oudkerk, Matthijs

de Groot, Jan Cees

van der Harst, Pim

de Bock, Geertruida H

De Deyn, Peter Paul

Vliegenthart, Rozemarijin

Abstract

Aim: Coronary artery disease (CAD) and cognitive impairment are common in the elderly, with evidence for shared risk factors and pathophysiological processes. The coronary artery calcium (CAC) score is a marker of subclinical CAD, which may allow early detection of individuals prone to cognitive decline. Prior studies on associations of CAC and clinical CAD with cognitive impairment had discrepant results. This systematic review aims to evaluate the association of (sub)clinical CAD with cognitive function, cognitive decline, and diagnosis of mild cognitive impairment (MCI) or dementia. Methods: A systematic search was conducted in MEDLINE, Embase, and Web of Science until February 2019, supplemented with citations tracking. Two reviewers independently screened studies and extracted information including odds ratios (ORs) and hazard ratios (HRs). Results: Forty-six studies, 10 on CAC and 36 on clinical CAD, comprising 1,248,908 participants were included in the systematic review. Studies about associations of (sub)clinical CAD with cognitive function and cognitive decline had heterogeneous methodology and inconsistent findings. Two population-based studies investigated the association between CAC and risk of dementia over 6–12.2 years using different CAC scoring methods. Both found a tendency toward higher risk of dementia as CAC severity increased. Meta-analysis in 15 studies (663,250 individuals) showed an association between CAD and MCI/dementia (pooled OR 1.32, 95%CI 1.17–1.48) with substantial heterogeneity (I2=87.0%, p＜0.001). Pooled HR of CAD for incident MCI/dementia over 3.2–25.5 years in six longitudinal studies (70,060 individuals) was 1.51 (95%CI 1.24–1.85), with low heterogeneity (I2=14.1%, p=0.32). Sensitivity analysis did not detect any study that was of particular influence on the pooled OR or HR. Conclusions: Limited evidence suggests the CAC score is associated with risk of dementia. In clinical CAD, risk of MCI and dementia is increased by 50%, as supported by stronger evidence.

Language

English

Source (journal)

Journal of Atherosclerosis and Thrombosis

Publication

2020

ISSN

1340-3478

DOI

10.5551/JAT.52928

Volume/pages

27 :9 (2020) , p. 934-958