People with Diabetes and Cognitive Decline May Be at Higher Risk for Heart Disease

People with type 2 diabetes who have cognitive impairment could be at greater risk for stroke, heart attack, or death than other individuals with diabetes, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology and Metabolism.

Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life. More than 16 million people in the U.S. are living with cognitive impairment, and age is the biggest risk factor. Cognitive impairment ranges from mild to severe and has been associated with Alzheimer’s disease, heart disease, stroke, and diabetes.

“Our study found low scores on cognitive tests predicted heart disease in people with diabetes and other heart risk factors,” says co-author Hertzel C. Gerstein, MD, of McMaster University in Hamilton, Canada. “Although the explanation for this remains unclear, proven heart medications should be offered to these patients to reduce their future risk of a heart attack or stroke.”

The researchers assessed the relationship between cognitive function and future cardiovascular events in 8,772 people with type 2 diabetes from the REWIND trial during more than five years of follow up. They found that people with the lowest level of cognitive function had a higher risk of heart attack and stroke than those with higher levels of cognitive function.

People with severe cognitive impairment were up to 1.6 times more likely to experience major adverse cardiovascular events, and 1.8 times more likely to experience a stroke or die compared to people without cognitive impairment. These findings suggest cognitive function could predict a person’s future risk of heart disease.

Other authors of this study include: Tali Cukierman-Yaffe of Tel Aviv University in Tel Aviv, Israel; Stephanie Hall, Purnima Rao-Melacini and Chinthanie Ramasundarahettige of McMaster University in Hamilton, Canada; Jan Basile of the Ralph H. Johnson VA Medical Center in Charleston, S.C.; M. Angelyn Bethel and Mark Lakshmanan of Eli Lilly and Company in Indianapolis, Ind.; Ernesto G. Cardona-Muñoz of the Centro Universitario de Ciencias de la Salud in Guadalajara, Mexico; Ignacio Conget of the Hospital Clínic de Barcelona in Barcelona, Spain; Gilles Dagenais of Laval University in Quebec City, Canada; Edward Franek of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Poland; Nicolae Hancu of Iuliu Hatieganu University of Medicine and Pharmacy in Cluj Napoca, Romania; Petr Jansky of Motol University Hospital in Prague; Fernando Lanas of the Universidad de La Frontera in Temuco, Chile; Lawrence A. Leiter of the University of Toronto in Toronto, Canada; Patricio Lopez Jaramillo of the University of Santander in Bucaramanga, Colombia; Valdis Pirags of Pauls Stradiņš Clinical University Hospital in Riga, Latvia; Nana Pogosova of the National Medical Research Center of Cardiology in Moscow, Russia; Jeffrey Probstfield of the University of Washington in Seattle, Wash.; Peter J. Raubenheimer of the University of Cape Town in Cape Town, South Africa; Matthew C. Riddle of the Oregon Health & Science University in Portland, Ore.; Lars Rydén of the Karolinska Institute in Stockholm, Sweden; Jonathan E. Shaw of Baker Heart and Diabetes Institute in Melbourne, Australia; Wayne H-H Sheu of Taichung Veterans General Hospital in Taichung, Taiwan; and Theodora Temelkova-Kurktschiev of the Robert Koch Medical Center in Sofia, Bulgaria.

The study received funding from Eli Lilly and Company.

The manuscript, “Novel Indices of Cognitive Impairment and Incident Cardiovascular Outcomes in the REWIND Trial,” was published online, ahead of print.