According to new research published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism, individuals may be at higher risk of heart attack, stroke, and death if they have cognitive impairment in addition to T2D.

Coauthor Hertzel C. Gerstein, MD, who is affiliated with the McMaster University in Hamilton, Canada, and colleagues, embarked upon their project to uncover potential novel indices of cognitive impairment and incident cardiovascular outcomes in the REWIND (Researching Cardiovascular Events with a Weekly Incretin in Diabetes) trial.

To test their hypothesis—which was that low cognitive scores are risk factors for adverse cardiovascular outcomes—the team included 8,772 individuals in their study cohort who completed both the Digit Substitution Test (DSST) and Montreal Cognitive Assessment (MoCA) at baseline. Subjects with baseline substantive cognitive impairment (SCI) were identified as having a baseline score on either the MoCA or DSST >1.5 standard deviations (SD) below either the score's country-specific mean or SCI-GM, which was based on a composite index of both scores calculated as their geometric mean (GM)and defined as a score that was >1.5 SD below their country's average GM.

The team reported their results with 10.3% (n = 905) of the study subjects with baseline SCI having a higher incidence of major adverse cardiac events (MACE; unadjusted hazard ratio [HR] 1.34; 95% CI 1.11, 1.62; P = .003) and stroke or death (unadjusted HR 1.60; 95% CI 1.33, 1.91; P <.001) when compared with the remaining 89.7% (n = 7,867) who were otherwise unaffected.

The authors concluded, "Country-standardized SCI-GM was a strong independent predictor of cardiovascular events in people with type 2 diabetes in the REWIND trial. Stronger relationships were noted for SCI-GM and MACE (unadjusted HR 1.61; 95% CI 1.28, 2.01; P <.001), and stroke or death (unadjusted HR 1.85; 95% CI 1.50, 2.30; P <.001). For SCI-GM but not SCI, all these relationships remained significant in models that adjusted for up to 10 SCI risk factors."

According to Dr. Gerstein, "Our study found low scores on cognitive tests predicted heart disease in people with diabetes and other heart risk factors." He elaborated, "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 authors further highlight the importance of their work, advising that their findings could translate into future benefit in patients, suggesting that ensuring routine screening for cognitive impairment in older individuals with a concurrent diagnosis of diabetes may result in the identification of a higher risk population and may allow proven cardioprotective therapies to be provided to improve outcomes.

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