Cardiovascular risk factors indirectly affect acute post-stroke cognition through stroke severity and prior cognitive impairment: a moderated mediation analysis

Introduction: Cognitive impairment may affect one third of the stroke survivors. Cardiovascular risk factors have been described to be risk factors for lower cognition after stroke. However, most previous studies only used multivariate regression models to learn the association. The aim of our study was to investigate whether the effect of cardiovascular risk factors on cognition after stroke was mediated by stroke severity, the estimated effect of direct and indirect pathways, and the moderated association. Method: In this incident cross-sectional study, 300 stroke patients received cognitive test within seven days after stroke. Cognitive tested was performed by the Chinese version of Mini-Mental State Examination (MMSE). A second stage dual moderated mediation model was used the select moderation variables. Finally, we constructed a structural equation model to test the indirect effects of cardiovascular and demographic factors on cognition stroke severity, the direct effects of predictors on cognition, and the moderated effects of hypertension. Results: Age (estimate, -0.114; 95% bias-corrected CI, -0.205, -0.032; P<0.001), female (estimate, -2.196; 95% bias-corrected CI, -4.359, -0.204; P=0.009), lower education (estimate, -0.893; 95% bias-corrected CI, -1.662, --0.160; P<0.001), stroke severity (estimate, -1.531; 95% bias-corrected CI, -3.015, -0.095), hypertension (estimate, -2.242; 95% bias-corrected CI, -4.436, -0.242; P=0.003) and atrial fibrillation (estimate, -4.930; 95% bias-corrected CI, -12.864, -0.126; P=0.048) were directly associated with lower cognitive function after stroke. We found no evidence that cardiovascular risk factors indirectly correlated cognitive function through stroke severity. The combination of hypertension could alleviate the negative effect of atrial fibrillation on cognition (estimate, -3.928; 95% bias-corrected CI, -7.954, 0.029; P=0.009). Conclusions: We explored the complex relationship between cardiovascular risk factors, stroke severity, and cognitive function after stroke. Using our method, researchers using other dataset could repeat the analysis and achieve a better understanding of the relationship. Future researchers are needed to find whether the moderated associations were casual or modifiable.

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Association between ApoE ε4 Carrier Status and Cardiovascular Risk Factors on Mild Cognitive Impairment among Mexican Older Adults

Brain Sciences ◽

10.3390/brainsci11010068 ◽

2021 ◽

Vol 11 (1) ◽

pp. 68

Author(s):

Sara G. Aguilar-Navarro ◽

Itzel I. Gonzalez-Aparicio ◽

José Alberto Avila-Funes ◽

Teresa Juárez-Cedillo ◽

Teresa Tusié-Luna ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Cardiovascular Risk ◽

Mild Cognitive Impairment ◽

Cardiovascular Risk Factors ◽

Apoe Genotype ◽

Carrier Status ◽

Apoe Ε4 ◽

Increased Risk

Mild cognitive impairment (MCI) (amnestic or non-amnestic) has different clinical and neuropsychological characteristics, and its evolution is heterogeneous. Cardiovascular risk factors (CVRF), such as hypertension, diabetes, or dyslipidemia, and the presence of the Apolipoprotein E ε4 (ApoE ε4) polymorphism have been associated with an increased risk of developing Alzheimer’s disease (AD) and other dementias but the relationship is inconsistent worldwide. We aimed to establish the association between the ApoE ε4 carrier status and CVRF on MCI subtypes (amnestic and non-amnestic) in Mexican older adults. Cross-sectional study including 137 older adults (n = 63 with normal cognition (NC), n = 24 with amnesic, and n = 50 with non-amnesic MCI). Multinomial logistic regression models were performed in order to determine the association between ApoE ε4 polymorphism carrier and CVRF on amnestic and non-amnestic-MCI. ApoE ε4 carrier status was present in 28.8% participants. The models showed that ApoE ε4 carrier status was not associated neither aMCI nor naMCI condition. The interaction term ApoE ε4 × CVRF was not statistically significant for both types of MCI. However, CVRF were associated with both types of MCI and the association remained statistically significant after adjustment by sex, age, and education level. The carrier status of the ApoE genotype does not contribute to this risk.

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Midlife cardiovascular risk factors and late cognitive impairment

European Journal of Epidemiology ◽

10.1007/s10654-013-9794-y ◽

2013 ◽

Vol 28 (5) ◽

pp. 405-416 ◽

Cited By ~ 43

Author(s):

Jyri J. Virta ◽

Kauko Heikkilä ◽

Markus Perola ◽

Markku Koskenvuo ◽

Ismo Räihä ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors

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Abstract W P121: Stroke Severity in Men and Women: What Proportion of the Disparity Can Be Explained by Differences in Cardiovascular Risk Factors?

Stroke ◽

10.1161/str.45.suppl_1.wp121 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Karen C Albright ◽

Amelia K Boehme ◽

Bisakha Sen ◽

Monica Aswani ◽

Michael T Mullen ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Sex Differences ◽

Cardiovascular Risk ◽

Black Women ◽

Cardiovascular Risk Factors ◽

Stroke Severity ◽

Stroke Subtype ◽

Oaxaca Decomposition ◽

Nihss Score

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.

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