Higher post-stroke ASCVD risk of 14.9% is associated with faster cognitive decline, particularly in women and stroke survivors under 75 years old.
Does higher post-stroke ASCVD risk predict faster post-stroke global cognitive decline in dementia-free individuals with incident stroke?
Higher post-stroke ASCVD risk, as estimated by the PREVENT score, is associated with faster cognitive decline, suggesting the score may have utility in estimating post-stroke cognitive risk, particularly in women and patients younger than 75.
Introduction: Modifiable risk factors for post-stroke cognitive decline remain uncertain and may differ by sex and age. Objective: To determine associations between post-stroke atherosclerotic cardiovascular disease (ASCVD) risk using a novel risk score and post-stroke cognitive function, overall and by sex and age. Methods: We pooled data from 1,855 dementia-free individuals with incident stroke (91% ischemic, 7% hemorrhagic; 52% women; 38% Black; median IQR age at stroke 75 69-80) from 4 cohorts (1971-2019): Atherosclerosis Risk In Communities Study, Cardiovascular Health Study, Framingham Offspring Study, and REasons for Geographic And Racial Differences in Stroke. We estimated time-dependent post-stroke ASCVD risk scores with the American Heart Association’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) 10-year ASCVD risk score. We used linear mixed-effects models to examine the association between time-dependent cumulative mean post-stroke 10-year ASCVD risk scores, treated as continuous and categorical (quintiles) variables, and global cognition, overall and stratified by sex and median age, adjusting for cohort and patient factors including mean pre-stroke global cognition. Median (IQR) follow-up was 4.1 (1.9, 7.5) years. Median (IQR) number of post-stroke cognitive measurements was 3 (2, 7). Results: Median (IQR) 10-year post-stroke ASCVD risk was 14.9% (11.1%-18.9%). Higher continuous and categorical post-stroke ASCVD risk was associated with both lower initial global cognition and faster decline in global cognition after stroke ( Table 1, Figure ). Women had faster post-stroke cognitive decline than men (P=0.03). The association between higher post-stroke ASCVD risk and faster post-stroke global cognitive decline was stronger in women than in men ( Table 2 ). Older stroke survivors (75+ years) had faster post-stroke cognitive decline than those under 75 years (P=0.001). Higher post-stroke ASCVD risk was significantly associated with faster post-stroke cognitive decline in stroke survivors younger than 75 years, but not those 75 years or older ( Table 2 ). Conclusions: Higher post-stroke ASCVD risk is associated with faster post-stroke global cognitive decline with stronger magnitudes in women and survivors younger than 75. While the PREVENT score is typically used for primary prevention in those aged 30-79, our results suggest it may have a role in estimating post-stroke cognitive decline risk, particularly for those younger than 75.
Levine et al. (2026) studied this question. Higher post-stroke ASCVD risk of 14.9% is associated with faster cognitive decline, particularly in women and stroke survivors under 75 years old.