1 Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand.
2 University of Auckland New Zealand.
J Am Heart Assoc. 2019 Apr 2;8(7):e010641. doi: 10.1161/JAHA.118.010641.
Background Vascular risk factors have been associated with differences in cognitive performance in epidemiological studies, but evidence in patients with coronary heart disease is more limited. Methods and Results The Montreal Cognitive Assessment score obtained 3.2±0.37 years after randomization to darapladib, a reversible inhibitor of lipoprotein phospholipase A or placebo was evaluated for 10 634 patients with coronary heart disease from 38 countries in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial. The Montreal Cognitive Assessment scores for darapladib and placebo groups were similar (mean± SD , 25.3±3.84 versus 25.4±3.73, respectively; P=0.27) and the adjusted odds ratio ( OR ) for mild cognitive impairment (Montreal Cognitive Assessment score <26) was 1.00 (95% CI , 0.93-1.09). Mild cognitive impairment was more likely with increasing age ( OR , 1.33 [1.27-1.41], +5 years after 65). For other baseline clinical characteristics, the strongest independent predictors of cognitive impairment were education (≤8 years versus college/university, OR , 2.95 [2.60-3.35]; >8 years/trade school versus college/university, OR , 1.38 [1.25-1.52] and geographic grouping). Cardiovascular risk factors independently associated with cognitive impairment were history of stroke ( OR , 1.43 [1.20-1.71]); <2.5 hours of moderate or vigorous intensity exercise/week ( OR , 1.19 [1.04-1.37]); high-density lipoprotein cholesterol <1.16 mmol/L ( OR , 1.19 [1.04-1.37]); diabetes mellitus requiring treatment ( OR , yes versus no: 1.15 [1.05-1.26]); and history of hypertension ( OR , 1.12 [1.02-1.23]). Conclusions In patients with stable coronary heart disease, cognitive performance was associated with modifiable cardiovascular risk factors, educational level, and global region, but was not influenced by darapladib. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00799903.
血管危险因素与流行病学研究中认知表现的差异有关，但在冠心病患者中的证据更为有限。
在 38 个国家的 10634 例冠心病患者中，评估了随机分组至脂蛋白磷脂酶 A 可逆抑制剂 darapladib 或安慰剂 3.2±0.37 年后的 Montreal Cognitive Assessment 评分。darapladib 组和安慰剂组的 Montreal Cognitive Assessment 评分相似（平均±标准差，25.3±3.84 与 25.4±3.73，分别；P=0.27），轻度认知障碍（Montreal Cognitive Assessment 评分<26）的调整比值比（OR）为 1.00（95%CI，0.93-1.09）。年龄越大，轻度认知障碍的可能性越大（OR，1.33 [1.27-1.41]，65 岁后增加 5 年）。对于其他基线临床特征，认知障碍的最强独立预测因素是教育程度（≤8 年与大学/大专，OR，2.95 [2.60-3.35]；>8 年/职业学校与大学/大专，OR，1.38 [1.25-1.52]和地理分组）。与认知障碍独立相关的心血管危险因素包括既往卒中史（OR，1.43 [1.20-1.71]）；每周中高强度运动<2.5 小时（OR，1.19 [1.04-1.37]）；高密度脂蛋白胆固醇<1.16mmol/L（OR，1.19 [1.04-1.37]）；需要治疗的糖尿病（OR，是比否：1.15 [1.05-1.26]）；以及高血压史（OR，1.12 [1.02-1.23]）。
在稳定型冠心病患者中，认知表现与可改变的心血管危险因素、教育水平和全球区域相关，但不受 darapladib 的影响。
http://www.clinicaltrials.gov。唯一标识符：NCT 00799903。
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