Key result
Coronary artery bypass grafting was associated with a higher risk of impaired cognition compared to non-CABG in patients with coronary artery disease (OR 1.23; 95% CI 1.06-1.41; p=0.005).
Why the study?
The association between coronary artery bypass graft (CABG) and impaired cognition (mild cognitive impairment or all-cause dementia) in coronary artery disease (CAD) patients, accounting for APO (ε) genotype, remains unclear.
Does coronary artery bypass graft (CABG) increase the risk of impaired cognition in older adults with coronary artery disease across different APO (ε) genotypes?
Cohort (n=22,349)
Does coronary artery bypass graft (CABG) increase the risk of impaired cognition in older adults with coronary artery disease across different APO (ε) genotypes?
CABG is associated with an increased risk of cognitive impairment in older adults with coronary artery disease, particularly among those with the APO ε2/ε3 genotype.
Answers are grounded in this paper and cite their sources.
CABG-associated cognitive risk should not yet change practice in CAD; leaves open causality versus confounding in observational data.
STRUCTERED ABSTRACT BACKGROUND Coronary artery bypass graft (CABG) is a widely performed procedure for coronary artery disease (CAD), yet its association with Impaired Cognition (IC), i.e., mild-cognitive impairment or all-cause dementia, while accounting for APO (ε) genotype, remains unclear. METHODS We analyzed AllofUS participants with CAD (Age≥60 yrs) from 2017-2023. We defined CAD as a history of angina/myocardial infarction/chronic ischemic heart disease or having percutaneous coronary intervention/CABG, and IC as mild cognitive impairment or all-cause dementia using ICD/SNOMED codes. We performed logistic regression analyses to assess the association between CABG and IC, adjusting for clinical factors (age, sex, hypertension, diabetes, hyperlipidemia, depression, stroke, smoking, alcohol use, statin/antihypertensive/antidiabetic use), social determinants (self-reported race/ethnicity, income, employment), and APO (ε) genotypes. We further performed stratified analyses across APO (ε) genotypes (ε2/ε2, ε2/ε3 ε3/ε3, ε2/ε4, ε3/ε4, ε4/ε4). We defined significance at p ≤ 0.05. RESULTS We included 22,349 with CAD and identified 908 with IC after CAD till 2023. 40% were females, 70% were White, 12% were Black, and 9% were Hispanic. The proportion of IC was higher ( 5.1% vs 3.5%, p=1e-08 ) in CABG (n=8,135) vs non-CABG (n=14,214). After adjusting for clinical factors, social determinants, and APO (ε) genotypes, CABG ( 1.23;1.06-1.41, p = 0.005 ) was associated with IC. In APO (ε) stratified analysis, the association of CABG with IC was strongest in the APO ε2/ε3 group ( 1.91;1.21-3.02, p = 0.005 ). CONCLUSION In the AllofUS cohort, we observed an association between CABG and IC in CAD participants, with the strongest association in the APO ε2/ε3 group. Key Message What is already known on this topic Coronary artery disease (CAD) and Impaired Cognitive (IC) disease, i.e., mild cognitive impairment and all-cause dementia, share genetic, sociodemographic, and clinical factors, including cardiovascular conditions like coronary artery bypass grafting (CABG) procedure. What this study adds We observed an association between CABG and IC in CAD participants after adjusting for sociodemographic, clinical factors, and APO (ε) effects. Further, when CAD participants were stratified across APO (ε) groups, CABG was significantly associated with IC in the APO ε2/ε3 group. How this study might affect research, practice or policy Our observations highlight the role of APO (ε) genotype evaluation in CAD patients for IC risk assessment.
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Hariharan et al. (2026) conducted a cohort in Coronary artery disease (n=22,349). Coronary artery bypass graft (CABG) vs. non-CABG was evaluated on Impaired Cognition (IC) (OR 1.23, 95% CI 1.06-1.41, p=0.005). Coronary artery bypass grafting was associated with a higher risk of impaired cognition compared to non-CABG in patients with coronary artery disease (OR 1.23; 95% CI 1.06-1.41; p=0.005).
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