Cardiovascular disease, associated risk factors, and risk of dementia: An umbrella review of meta-analyses

Jacob Brain; Leanne Greene; Eugene Y H Tang; Jennie Louise; Amy Salter; Sarah Beach; Deborah Turnbull; Mario Siervo; Blossom C M Stephan; Phillip J Tully

doi:10.3389/fepid.2023.1095236

Cardiovascular disease, associated risk factors, and risk of dementia: An umbrella review of meta-analyses

Front Epidemiol. 2023 Feb 9:3:1095236. doi: 10.3389/fepid.2023.1095236. eCollection 2023.

Authors

Jacob Brain^{1

2}, Leanne Greene², Eugene Y H Tang³, Jennie Louise⁴, Amy Salter⁵, Sarah Beach⁶, Deborah Turnbull², Mario Siervo⁷, Blossom C M Stephan¹, Phillip J Tully⁸

Affiliations

¹ Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Jubilee Campus, Nottingham, United Kingdom.
² Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Psychology, The University of Adelaide, Adelaide, SA, Australia.
³ Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
⁴ Discipline of Obstetrics & Gynaecology, the Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
⁵ School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
⁶ University of Nottingham Libraries, University of Nottingham, King's Meadow Campus, Nottingham, United Kingdom.
⁷ School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom.
⁸ Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia.

Abstract

Introduction: Cardiovascular diseases (CVDs) have been associated with an increased risk of dementia; yet the evidence is mixed. This review critically appraises and synthesises current evidence exploring associations between dementia risk and CVD and their risk factors, including coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidaemia, and arterial stiffness.

Methods: MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews with meta-analyses investigating the association between at least one of the CVDs of interest and dementia risk. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews was used to assess methodological quality.

Results: Twenty-five meta-analyses published between 2007 and 2021 were included. Studies largely consisted of cohorts from North America and Europe. Findings were variable, with coronary heart disease, heart failure, and atrial fibrillation consistently associated with increased risk for all-cause dementia, but results were inconsistent for Alzheimer's disease. Hypertension was more frequently associated with dementia during mid-life compared to late life. Findings concerning cholesterol were complex, and while results were inconsistent for low-density lipoprotein cholesterol and total cholesterol, there appeared to be no associations between triglycerides and high-density lipoprotein cholesterol. All meta-analyses investigating hypercholesterolaemia showed significant increases in dementia risk. There was a paucity of research on the association between arterial stiffness and dementia risk.

Conclusion: Targeted CVD dementia prevention strategies could reduce dementia prevalence. Future research should determine the underpinning mechanisms linking heart and brain health to determine the most effective strategies for dementia risk reduction in CVD populations.

Keywords: cardiovascular disease; dementia; dementia risk; epidemiology; protective factor; risk factors; umbrella review.

Publication types

Review

Grants and funding

This umbrella review was supported by the UKRI (Medical Research Council), grant number MR/X005437/1.