Predicting the Risk of Heart Disease and Dementia in Older Adults

The risk factors for cognitive decline significantly overlap with the risk factors for cardiovascular disease. If you look at the list of 14 modifiable risk factors for dementia, it's almost like reading a list of the risk factors I think about at my cardiology clinic.

These modifiable risk factors may prevent more than 40% of dementias. We need better ways to help patients understand their personal risk so we can help prevent both cardiovascular disease and dementia, including Alzheimer's disease.

Doctors who provide preventive cardiovascular care use a 10-year ASCVD risk calculator to predict the risk of ASCVD in their patients. However, previous research has shown that these models are less effective for older adults. The predictors used to assess risk in a 40-year-old don’t behave the same way when applied to someone who is 80.

We set out to develop predictive models that perform better for older people and consider the outcomes, like cognition, that older people care about most. To create the models, we used novel predictors, including factors like mobility, baseline cognition, and function.

Our study found that including functional measures – like the ability to shop for groceries independently and baseline mobility – improves risk prediction for cognitive impairment.

Many of the standard treatments we deliver to patients, including anti-anginal medications like beta blockers and calcium channel blockers, have potential or hypothesized impacts on cognition, but it’s not something that is measured in cardiovascular clinical trials. Through a new award, we are investigating whether these treatments affect cognitive status over time. While we’re still in the early phases of this research, I’m hopeful we can add to the evidence base to help doctors and patients find treatments that reflect the patients’ goals.

I’m also excited to work on a project funded by the Pepper Scholar Award to create a shared decision-making tool called “Consider, Listen, Decide,” to help older adults make complex decisions around the treatment of coronary disease.

I recently launched the HeartWise Lab with my colleague Dr. Abdulla Damluji to explore many of these questions. For example, our group recently published a review in JACC examining types of cognitive impairment prevalent among cardiac patients and some of the evidence-based management strategies that help mitigate cognitive impairment in this population. The goal for all of our research is to bridge the gap between traditional cardiovascular treatments and the unique priorities of older adults. We want to ensure that therapies not only extend life but also preserve patients' function, independence, and quality of life.