Type 2 diabetes with cognitive impairment linked to adverse cardiovascular outcomes

Type 2 diabetes patients with cognitive impairment appear to be at increased risks of stroke, heart attack or death compared with non-diabetic patients.

Researchers reported their findings on April 21, 2022 in the Journal of Clinical Endocrinology and Metabolism.

Cognitive impairment is trouble in everyday living with remembering, learning, concentrating or making. “Our study found low scores on cognitive tests predicted heart disease in people with diabetes and other heart risk factors,” said co-author Hertzel C. Gerstein, M.D., endocrinologist and professor at McMaster University in Hamilton, Ontario, Canada “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 investigators included data from 8,772 subjects in the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial who had completed both the Montreal Cognitive Assessment (MoCA) score and Digit Substitution Test (DSST) at baseline.

The scores identified subjects with substantive cognitive impairment (SCI), with a baseline score on either the  MoCA or DSST ≥1.5 standard deviations (SD) below either score’s country-specific mean, or SCI-Geometric Mean (GM),  which is a composite of both scores (MoCA and DSST) with a score ≥ 1.5 SD below their country’s average geometric mean.

The investigators analyzed correlations between these cognitive measures and major adverse cardiovascular events (MACE) of either stroke or death.

They reported that, when compared with 7,867 (89.7%) unaffected subjects, 905 (10.3%) subjects with baseline substantive cognitive impairment (SCI) had a significantly higher incidence of MACE (P = 0.003), and stroke or death (P < 0.001).

They also found stronger statistical correlations between SCI-GM and MACE (P < 0.001), and stroke or death (P < 0.001).

In other words, type 2 diabetes subjects with severe cognitive impairment were up to 1.6 times more likely to experience major adverse cardiovascular events, and 1.8 times more likely to experience a stroke or die compared to people with no cognitive impairment, suggesting that cognitive function might be a marker for risk of heart disease in this population.