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Coronary Heart Disease By Age 45 Linked With Later Dementia

Younger onset age of coronary heart disease was tied to higher risks of incident all-cause dementia, Alzheimer's disease, and vascular dementia, a large prospective cohort study in Great Britain showed.

Each 10-year decrease in coronary heart disease onset age was associated with a 25% increased risk of all-cause dementia, a 29% increased risk of Alzheimer's disease, and a 22% increased risk of vascular dementia (all P<0.001), reported Fanfan Zheng, PhD, of the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and co-authors in the Journal of the American Heart Association.

Across all age groups, coronary heart disease diagnosed before age 45 had the highest hazard ratio (HR) for incident dementia compared with people who didn't have coronary heart disease (HR 2.40, P<0.001).

"Coronary heart disease has previously been associated with dementia risk in older adults, however, this is believed to be the first large-scale study examining whether the age of coronary heart disease onset may impact the risk of developing dementia later in life," Zheng said in a statement.

"In previous research, we found that adults experienced accelerated cognitive decline after new diagnoses of coronary heart disease," she added.

The researchers assessed data from 432,667 participants in the ongoing U.K. Biobank study. Participants had a mean age of 57 at baseline and about 55% were women. Overall, 11.7% (50,685 people) had coronary heart disease at the time of enrollment and through the follow-up period.

Over a median follow-up of 12.8 years, 5,876 cases of all-cause dementia, 2,540 cases of Alzheimer's disease, and 1,220 cases of vascular dementia emerged.

After adjusting for multiple covariates ranging from age and sex to BMI and statin use, people with coronary heart disease had a 36% increased risk of all-cause dementia (P<0.001), 13% greater risk of Alzheimer's (P=0.019), and 78% higher risk of vascular dementia (P<0.001) compared with all other participants who didn't have coronary heart disease.

In a propensity score-matched analysis, people with coronary heart disease had significantly higher risks of dementia than matched controls in all onset age groups. Hazard ratios rose with decreasing onset age.

Compared with people who had coronary heart disease onset at age 60 or older, those with onset at age 45 or younger had a 71% higher risk of all-cause dementia (P<0.001), 75% higher risk of Alzheimer's disease (P=0.003), and 65% higher risk of vascular dementia (P=0.015).

"What surprised us most was the linear relationship between age of coronary heart disease onset and dementia. This shows the huge detrimental influence of premature coronary heart disease on brain health," Zheng said.

"As more people live longer and are diagnosed with coronary heart disease at a younger age, it's likely there will be a large increase in the number of people living with dementia in years to come," she observed.

"Healthcare professionals should be aware of individuals diagnosed with coronary heart disease at a young age," Zheng added. "The next step is to determine whether modifying cardiovascular risk early in life will promote better brain health later in life."

The study was observational, so cause and effect cannot be determined, the researchers noted. More than 94% of the study population were white, and the findings may not apply to people of other races or ethnicities, they acknowledged.

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer's, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson's, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

This study was supported by the National Natural Science Foundation of China, the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences, and the 2022 China Medical Board-Open Competition research grant.

The researchers reported no disclosures.

Primary Source

Journal of the American Heart Association

Source Reference: Liang J, et al "Association between onset age of coronary heart disease and incident dementia: a prospective cohort study" J Am Heart Assoc 2023; DOI: 10.1161/JAHA.123.031407.

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ADHD Medications Can Increase Risk Of Heart Disease, Study Finds

A new study said long-term use of Attention-Deficit/Hyperactivity Disorder (ADHD) medications can raise the risk of cardiovascular disease.

Researchers in Sweden followed the medical records of thousands of individuals with the disorder for years.

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They found overall heart disease risk was 23% higher for people who used ADHD medication for more than five years compared to those who did not.

Doctors commonly prescribe stimulants to treat ADHD which are known to elevate blood pressure, making the heart work harder.

Experts say patients need to be aware of the risks.

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High Doses Of ADHD Medication Over A Long Period Could Increase Risk Of Heart Disease

People who take medication for attention deficit hyperactivity disorder (ADHD) for long periods of time and at high doses may be at an increased risk of some cardiovascular diseases, new research suggests.

ADHD is a common neurodevelopmental disorder characterised by having trouble focusing and controlling impulsive behaviour.

In a study of more than 278,000 Swedish ADHD patients aged 6 to 64, researchers found a statistically significant risk for patients taking these medications at doses higher than 1.5 times the daily average.

They also found that each one-year increase in medication use was associated with a 4 per cent increase in the risk of cardiovascular disease.

Long-term use of ADHD medication was associated especially with an increased risk of hypertension and arterial disease.

Methylphenidate, marketed as Ritalin, Concerta, Equasym, Medikinet, or Rubife, was the most commonly dispensed ADHD medication.

It is prescribed to enhance activity in areas of the brain that control attention and impulsive behaviour.

"There is a long list of drugs that have been linked to a comparable increased risk of hypertension when used long-term such as the one found here, so patients should not be alarmed by these findings," Le Zhang, a postdoc researcher at Karolinska Institutet in Sweden and first author of the study, said in a statement.

"However, in clinical practice, the raised risk should be carefully weighed against the recognised benefits of treatment on a case-by-case basis," she said.

"Doctors should also regularly follow up the ADHD patients to find signs and symptoms of cardiovascular disease while they're on medication over the long-term".

The findings were published in the journal Jama Psychiatry.

As an observational study, it did not determine a causal link between ADHD medication and cardiovascular disease, but the researchers said the findings showed the importance of determining "potential benefits and risks when making treatment decisions about long-term ADHD medication use".

Researchers found in a second study, however, that more than half of teenagers, young adults, and adults who start taking ADHD medication stopped doing so within the first year.

The multinational study also found that 35 per cent of children who started taking their ADHD medication stopped taking it in the first year.

"It's unlikely that so many people discontinue their treatment because their ADHD symptoms have remitted, meaning that the high rate of early discontinuation may be a major barrier to effective treatment," said Zheng Chang, a senior researcher at Karolinska Institutet who led both studies.

"We haven't been able to analyse the direct causes in this study, but common reasons for discontinuing ADHD medication are adverse reactions and lack of effect".

The researchers analysed prescription data from more than 1.2 million patients in Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, the UK, Sweden and the USA and found the same pattern in every region.

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