Bazzano, Lydia

Background: Despite the growing interest in the role of isolated left ventricular (LV) diastolic dysfunction in cardiac remodeling, little is known about its association with cognitive performance in midlife, prior to the onset of dementia. Hypothesis: We hypothesized that LV diastolic dysfunction and cardiac remodeling will be associated with cognitive performance in middle-aged adults. These associations might differ by sex and race. Aim: To investigate the impact of left atrial (LA) size, LV mass, volume, systolic and diastolic function on cognition in middle-aged Black and White, men and women from a rural, community-based cohort, the Bogalusa Heart Study (BHS), in Louisiana. Methods: A total of 1,107 participants from the BHS (48.1±5.4 years, 56.7% female, 34.3% black) with echocardiography and cognitive testing were included. Cognitive performance was quantified in a global cognitive score (GCS) comprised of the z standardized sum of 7 neuropsychiatric tests. Multivariate linear regression analysis was used for the association of E/e’, LA volume index (LAVi), LV end-diastolic volume (LVEDV), mass index (LVMi) as well as ejection fraction (LVEF) with GCS adjusted for age, sex, race, systolic and diastolic blood pressure, total and HDL cholesterol, history of smoking, diabetes, and hypertension as well as education. Interactions by sex and race were tested. Results: Even after adjusting for age, sex and race, larger LAVi, LVEDV, LVMi, higher E/e’ and lower e’ were associated with poorer cognitive function (all p <0.05), but not LVEF. These associations remained significant for E/e’, e’, and LVMi after adjusting for systolic and diastolic blood pressure, total and HDL cholesterol, history of smoking, diabetes, hypertension, as well as education. There was no significant race interaction. In contrast, the association of E/e’ with GCS was significantly stronger (standardized β coefficient =-0.20; p <0.01) in middle-aged women, but not in middle-aged men (standardized β coefficient =-0.04; p <0.36; p interaction=0.02). Conclusion: LV diastolic function is more closely associated with mid-life cognition than systolic function, and the association is present among middle aged women but not men.

Background: Little is known about the relationship between carotid plaque formation and cognitive function in a middle-aged population. Hypothesis: We hypothesize that there will be an association between carotid atherosclerotic burden and cognitive function in middle-aged adults. Aim: The purpose of the present study is to examine the relationship between carotid artery (CA) plaque and cognitive function in middle-aged white and black men and women from the Bogalusa Heart Study (BHS) cohort. Methods: We included a total of 1,107 BHS participants with echocardiography and carotid ultrasound performed between 2013 and 2016. Cognitive function was quantified in a global cognitive score (GCS) comprised of the z standardized sum of 7 neuropsychiatric tests. CA plaque was defined by carotid intima media thickness ≥1.5mm in any segment of the CA including right and left common artery (RCC/LCC), bulbs (RCB/LCB) as well as right and left internal carotid artery (RIC/LIC). We compared demographic, clinical, and echocardiographic characteristics in participants with or without CA plaque and used linear regression analysis for the association between CA and GCS adjusted for age, sex, race and education. Results: Among all, 373 (33.7%) of participants had one or more CA plaque. The most common locations of CA plaque formation differed according to laterality, with 230 (61.7%), 189 (50.7%), 108 (29.0%), 92 (24.7%), 83 (22.3%), 10 (2.7%) participants having plaque in the RCB, LCB, LCA, RIC, LIC, and RCA, respectively. Participants with CA plaque were likely to be older (49.9 vs. 47.2 years), male (52 vs.38.9%), white (70.2 vs.63.4%,), have larger left ventricular (LV) end-diastolic volume (97.4 vs.94 ml) and LV mass index (83.4 vs.76.3 g/m 2 , all p -value<0.01), but similar LV ejection fraction (60.1 vs.60.0%) as compared to those without CA plaque. Moreover, CA is associated with poorer cognitive function (GCS, standardized β coefficient=-0.07; p =0.02) adjusted for age, sex, and race. However, the association was attenuated after adjusting for education. Conclusion: CA plaque was highly prevalent and inversely associated with cognitive function. The association was attenuated by education emphasizing the importance of social determinants in cognitive health.

Abstract Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double‐blind, placebo‐controlled randomized pragmatic clinical trial, will compare high‐intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community‐dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site‐reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co‐secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.