Eslami Mohammad Hossein, Sedokani Amin, Panahi Nekoo, Sharifi Farshad, Payab Moloud, Ebrahimpour Mahbube, Zarinfar Yasaman, Fahimfar Noushin, Nabipour Iraj, Heshmat Ramin, Larijani Bagher, Ostovar Afshin
Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
BMC Geriatr. 2025 Aug 11;25(1):614. doi: 10.1186/s12877-025-06224-w.
Cognitive decline is a major challenge to global public health, especially among older adults. A high Atherogenic Index of Plasma (AIP) is linked to cerebral small vessel disease, which may increase the risk of cognitive decline. This study aims to evaluate the association between AIP and cognitive impairment in a sample of older adults in Iran.
The study enrolled 2373 individuals (51.5% women) aged more than 60 years participating in the second phase of the Bushehr Elderly Health Program. Cognitive impairment was defined by combining the two methods: Categorical verbal fluency tests, and Mini-Cog. The AIP was obtained by Log (molar serum triglyceride/HDL). The connection between AIP and cognitive function was evaluated. Since statin use is an essential factor affecting the lipid profile, the analysis was stratified according to statin use and adjusted for possible confounders as well.
According to either assessment method, 1423 (60%) individuals were determined to have cognitive impairment. Overall, those with impaired cognition differed significantly from others regarding age, sex (higher in women), marital status, antihyperlipidemic medication (either fibrates or statins), diabetes, depression, low physical activity, and some lipid parameters (Cholesterol, LDL-C, non-HDL-C). After stratification, we observed that in statin users, high-risk AIP category (AIP > 0.21) was significantly associated with cognitive impairment [OR: 1.38 (1.02-1.87)] and continued to be significant after adjustment for confounders [1.48 (1.07-2.05)]. Other significant contributing factors include age [1.08 (1.06, 1.11); 1.07 (1.04, 1.10)] and sex [0.36 (0.28, 0.46); 0.47 (0.33, 0.65)] in non-statin and statin users; smoking [1.16 (1.01, 1.33)], low physical activity [1.42 (1.02, 1.99)], depression [1.6 (1.09, 2.35)], and diabetes [1.68 (1.28, 2.19)] in non-statin group; and education levels [1.53 (1.06, 2.19)] in statin users.
Our finding suggests that a high AIP despite using statins, is associated with an increased risk of cognitive impairment. Smoking, low physical activity, depression, and diabetes in non-statin users, and low education in statin users are determinants of impaired cognitive function. It is important to monitor AIP levels and address associated risk factors to mitigate the risk of cognitive impairment and neurodegenerative conditions.
认知功能衰退是全球公共卫生面临的一项重大挑战，在老年人中尤为如此。高血浆致动脉粥样硬化指数（AIP）与脑小血管疾病相关，这可能会增加认知功能衰退的风险。本研究旨在评估伊朗老年人群样本中AIP与认知障碍之间的关联。
该研究纳入了2373名年龄超过60岁的个体（51.5%为女性），他们参与了布什尔老年人健康项目的第二阶段。认知障碍通过两种方法相结合来定义：分类语言流畅性测试和简易认知评估量表（Mini-Cog）。AIP通过Log（血清摩尔甘油三酯/高密度脂蛋白）获得。评估了AIP与认知功能之间的联系。由于他汀类药物的使用是影响血脂谱的一个重要因素，因此分析根据他汀类药物的使用情况进行分层，并对可能的混杂因素进行了调整。
根据任何一种评估方法，有1423名（60%）个体被确定存在认知障碍。总体而言，认知功能受损者在年龄、性别（女性比例更高）、婚姻状况、抗高血脂药物（贝特类或他汀类）、糖尿病、抑郁症、低体力活动以及一些血脂参数（胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇）方面与其他人存在显著差异。分层后，我们观察到在他汀类药物使用者中，高风险AIP类别（AIP＞0.21）与认知障碍显著相关[比值比（OR）：1.38（1.02 - 1.87）]，在对混杂因素进行调整后仍然显著[1.48（1.07 - 2.05）]。其他显著的影响因素包括非他汀类药物使用者和他汀类药物使用者中的年龄[1.08（1.06，1.11）；1.07（1.04，1.10）]和性别[0.36（0.28，0.46）；0.47（0.33，0.65）]；非他汀类药物组中的吸烟[1.16（1.01，1.33）]、低体力活动[1.42（1.02，1.99）]、抑郁症[1.6（1.09，2.35）]和糖尿病[1.68（1.28，2.19）]；以及他汀类药物使用者中的教育水平[1.53（1.06，2.19）]。
我们的研究结果表明，尽管使用了他汀类药物，但高AIP仍与认知障碍风险增加相关。非他汀类药物使用者中的吸烟、低体力活动、抑郁症和糖尿病，以及他汀类药物使用者中的低教育水平是认知功能受损的决定因素。监测AIP水平并处理相关风险因素对于降低认知障碍和神经退行性疾病的风险很重要。
