School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Gerontology. 2024;70(2):143-154. doi: 10.1159/000535284. Epub 2023 Nov 20.
Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women.
A total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio.
Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]).
These findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.
心血管疾病（CVD）的风险因素也会增加痴呆的风险。然而，在没有 CVD 病史的老年人群中，常用的 CVD 风险评分是否与痴呆风险相关，以及这种相关性是否存在潜在的性别差异，目前尚不清楚。本研究旨在确定 CVD 风险评分是否与最初健康的老年男性和女性的认知能力下降和痴呆相关。
从一个年龄在 65 岁及以上、无已知 CVD 或痴呆的前瞻性队列中招募了 19114 名参与者。在基线时计算了动脉粥样硬化性心血管疾病风险评分（ASCVDRS）、系统冠状动脉风险评估 2-老年人（SCORE2-OP）和弗雷明汉风险评分（FRS）。使用风险比评估痴呆（根据 DSM-IV 标准）和认知能力下降（定义为与前一年相比，全球认知、情景记忆、精神运动速度或言语流畅性下降超过 1.5 个标准差）的风险。
在中位数为 6.4 年的随访期间，850 人发生痴呆，4352 人发生认知能力下降。与最低三分位相比，ASCVDRS 最高三分位的男性和女性痴呆风险分别增加了 41%（95%CI 1.08，1.85）和 45%（1.11，1.89）。同样，SCORE2-OP 最高三分位的男性和女性痴呆风险分别增加了 64%（1.24，2.16）和 60%（1.22，2.11）。这些发现类似，但在检查 ASCVDRS 和 SCORE2-OP 的认知能力下降风险时，风险略低。然而，FRS 仅与女性认知能力下降的风险相关（最高与最低三分位相比：1.13 [1.01-1.26]）。
这些发现表明 ASCVDRS 和 SCORE2-OP 在临床实践中的实用性，不仅可以评估未来 CVD 的风险，还可以作为认知障碍的潜在早期指标，即使在相对健康的老年男性和女性中也是如此。
