Impact of risk factor burden and vascular bed involvement on dementia risk in individuals with established cardiovascular disease

To determine how cardiovascular disease (CVD) risk factor burden and vascular bed involvement relate to the risk of dementia in individuals with established CVD. Participants were from the prospective, single-center UCC-SMART cohort study, recruited between 1996-2024. CVD risk factor burden was defined as the number of CVD risk factors present. The number of affected vascular beds was the count of coronary artery disease, cerebrovascular disease, and peripheral artery disease. Relations with all-cause dementia were estimated with Cox regression adjusted for confounders. Among 10,321 participants (mean age 61±10 years; 27% female), 296 developed dementia during a median follow-up of 10.1 years (IQR 5.0-15.7). Dementia risk increased with higher CVD risk factor burden: compared with 0-1 risk factors, hazard ratios were 1.35 (95% CI 0.95-1.92) for 2 risk factors, 1.58 (95% CI 1.10-2.26) for 3 risk factors, and 1.87 (95% CI 1.31-2.67) for 4-9 risk factors. Compared with 1 affected vascular bed, the hazard ratios were 1.32 (95% CI 1.02-1.71) for 2 affected vascular beds and 1.90 (95% CI 1.05-3.43) for 3 affected vascular beds. Dementia risk was higher in participants with peripheral artery disease (HR 1.68; 95% CI 1.24-2.28) and cerebrovascular disease (HR 2.09; 95% CI 1.61-2.71) than in those with coronary artery disease. Higher CVD risk factor burden and involvement of multiple vascular beds are related to increased dementia risk in individuals with established CVD. These findings underscore the importance of stringent cardiovascular risk management as a potential strategy to lower dementia risk in this population.