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Monday, April 11, 2016

CVD x Dementia (80+)

Teremos que escolher entre morrer do coração x demenciar???

Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years

Lewis H. Kuller, MD, DRPH; Oscar L. Lopez, MD; Rachel H. Mackey, PHD, MPH; Caterina Rosano, MD, MPH; Daniel Edmundowicz, MD; James T. Becker, PHD; Anne B. Newman, MD, MPH
J Am Coll Cardiol. 2016;67(9):1013-1022. 

Abstract and Introduction


Background The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia.
Objectives The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores.
Methods We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years).
Results Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia.
Conclusions In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133)


      A very important unanswered question is whether 0 or very low CAC scores or other measures of lower extent of atherosclerosis or arteriosclerosis are associated with reduced risk of incident dementia. Interventions to modify known risk factors to prevent the progression of atherosclerosis and arteriosclerosis could result in a decreased older-age incidence of CHD, CVD, and dementia. The alternative could be an unfortunate outcome: that successful control of risk factors and treatment of CHD results in an increasing epidemic of dementia among older people.

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