Samimisedeh Parham, Kazibwe Richard, Schaich Christopher L, Hughes Timothy M, Soliman Elsayed Z
Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
Hospital Medicine, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
J Clin Med. 2025 Jul 7;14(13):4791. doi: 10.3390/jcm14134791.
The association between atrial fibrillation (AF) and dementia and cognitive decline in individuals with hypertension is not well established. : The Systolic Blood Pressure Intervention Trial (SPRINT) enrolled participants with hypertension at high risk of cardiovascular disease (CVD) but without diabetes or a history of stroke. Participants with baseline pre-existing clinical dementia, prescribed dementia medications, or missing AF or cognition data were excluded. AF was identified using centrally read electrocardiograms. Mild cognitive impairment (MCI) and probable dementia (PD) were determined during follow-up by an adjudication committee. Multivariable Cox proportional hazards regression models were employed to assess the association of time-dependent AF with MCI, PD, and a composite endpoint of MCI/PDI. : A total of 8539 participants (mean age: 67.9 years; 35.1% female) were included in the analysis. Of these, 264 had AF at baseline or during follow-up. Over a median follow-up period of 5 years, 318 PD, 625 MCI, and 849 composite PD or MCI events occurred. In models adjusted for treatment assignment, baseline sociodemographics, CVD risk factors, and potential confounders, time-dependent AF was associated with incident PD, MCI, and a composite endpoint of MCI/PDI [HR (95% CI): 1.84 (1.09, 3.13), 1.59 (1.01, 2.53), and 1.63 (1.12, 2.38), respectively]. Further adjustment for incident stroke did not significantly change these associations. : AF is associated with an increased risk of dementia and cognitive impairment in patients with hypertension but not diabetes or stroke. Further research is needed to determine whether AF management strategies can mitigate cognitive decline.
心房颤动（AF）与高血压患者的痴呆和认知功能下降之间的关联尚未明确。收缩压干预试验（SPRINT）纳入了有心血管疾病（CVD）高风险但无糖尿病或中风病史的高血压患者。排除了基线时已存在临床痴呆、正在服用痴呆药物或缺失房颤或认知数据的参与者。使用中央读取的心电图来识别房颤。在随访期间，由一个判定委员会确定轻度认知障碍（MCI）和可能的痴呆（PD）。采用多变量Cox比例风险回归模型来评估时间依赖性房颤与MCI、PD以及MCI/PDI复合终点之间的关联。共有8539名参与者（平均年龄：67.9岁；35.1%为女性）纳入分析。其中，264人在基线或随访期间发生房颤。在中位随访期5年期间，发生了318例PD、625例MCI以及849例PD或MCI复合事件。在调整了治疗分配、基线社会人口统计学、CVD危险因素和潜在混杂因素的模型中，时间依赖性房颤与新发PD、MCI以及MCI/PDI复合终点相关[风险比（95%置信区间）：分别为1.84（1.09，3.13）、1.59（1.01，2.53）和1.63（1.12，2.38）]。进一步对新发中风进行调整并没有显著改变这些关联。房颤与高血压但无糖尿病或中风患者的痴呆和认知障碍风险增加相关。需要进一步研究以确定房颤管理策略是否可以减轻认知功能下降。
