Olesen Kevin K W, Thrane Pernille G, Gyldenkerne Christine, Thomsen Reimar W, Mortensen Janne K, Kristensen Steen D, Maeng Michael
Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Department of Cardiology, Regional Hospital Gødstrup, Hospitalsparken 15, 7400 Herning, Denmark.
Eur J Prev Cardiol. 2025 Apr 22;32(6):477-484. doi: 10.1093/eurjpc/zwae153.
Diabetes is associated with an increased risk of dementia, but it is still debated to which degree this risk depends on the presence of atherosclerotic cardiovascular disease (CVD). In this study, we hypothesize that patients with diabetes and coexisting coronary artery disease (CAD), as a marker of systemic atherosclerotic CVD, have a substantially higher risk of developing dementia.
Patients ≥65 years, who underwent coronary angiography, were stratified by diabetes and CAD. Outcomes were all-cause dementia, Alzheimer's dementia, and vascular dementia. We estimated adjusted hazard ratios (aHRs) using patients with neither diabetes nor CAD as a reference. A total of 103 859 patients were included. Of these, 23 189 (22%) had neither diabetes nor CAD, 3876 (4%) had diabetes, 61 020 (59%) had CAD, and 15 774 (15%) had diabetes and CAD. During a median follow-up of 6.3 years, 5592 (5.5%) patients were diagnosed with all-cause dementia. Patients with diabetes and CAD had the highest HR of all-cause dementia [aHR 1.37, 95% confidence interval (CI) 1.24-1.51], including Alzheimer's dementia (aHR 1.41, 95% CI 1.23-1.62) and vascular dementia (aHR 2.03, 95% CI 1.69-2.45). Patients with diabetes alone (aHR 1.14, 95% CI 0.97-1.33) or CAD alone (aHR 1.11, 95% CI 1.03-1.20) had a modestly increased rate of all-cause dementia.
The combination of diabetes and CAD is associated with an increased rate of dementia, in particular vascular dementia, suggesting that the diabetes-related risk of dementia is partly mediated through concomitant atherosclerotic CVD. This underscores the importance of atherosclerotic CVD prevention in diabetic patients to reduce cognitive decline.
糖尿病与痴呆风险增加相关，但这种风险在多大程度上取决于动脉粥样硬化性心血管疾病（CVD）的存在仍存在争议。在本研究中，我们假设患有糖尿病并伴有冠状动脉疾病（CAD）的患者，作为全身性动脉粥样硬化性CVD的一个标志，发生痴呆的风险显著更高。
对≥65岁接受冠状动脉造影的患者，按糖尿病和CAD进行分层。结局指标为全因痴呆、阿尔茨海默病性痴呆和血管性痴呆。我们以既无糖尿病也无CAD的患者作为对照，估计校正风险比（aHRs）。共纳入103859例患者。其中，23189例（22%）既无糖尿病也无CAD，3876例（4%）患有糖尿病，61020例（59%）患有CAD，15774例（15%）患有糖尿病且伴有CAD。在中位随访6.3年期间，5592例（5.5%）患者被诊断为全因痴呆。患有糖尿病且伴有CAD的患者全因痴呆的HR最高[aHR 1.37，95%置信区间（CI）1.24 - 1.51]，包括阿尔茨海默病性痴呆（aHR 1.41，95% CI 1.23 - 1.62）和血管性痴呆（aHR 2.03，95% CI 1.69 - 2.45）。仅患有糖尿病的患者（aHR 1.14，95% CI 0.97 - 1.33）或仅患有CAD的患者（aHR 1.11，95% CI 1.03 - 1.20）全因痴呆发生率有适度增加。
糖尿病与CAD并存与痴呆发生率增加相关，尤其是血管性痴呆，这表明糖尿病相关的痴呆风险部分是通过伴随的动脉粥样硬化性CVD介导的。这凸显了在糖尿病患者中预防动脉粥样硬化性CVD以减少认知衰退的重要性。
