Association between cognitive trajectories and cardiovascular disease: a prospective cohort study

Cardiovascular disease (CVD) and cognitive decline frequently co-occur in aging populations, with growing evidence implicating shared vascular and metabolic pathways in their pathophysiology. However, whether longitudinal patterns of cognitive change associated with subsequent CVD risk remains unclear, and the potential modifying influence of metabolic conditions—such as diabetes and dyslipidemia—on this association has not been fully elucidated. This study aimed to investigate the association between cognitive trajectories and incident CVD in older adults, with particular attention to the role of metabolic comorbidities. This nationwide cohort study was based on data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 1,830 participants aged ≥ 65 years without baseline CVD were included. Cognitive function was assessed from 2011 to 2015. Latent class mixed models were applied to identify cognitive trajectories. Incident CVD was ascertained in 2018. Multivariable logistic regression models were used to examine associations between cognitive trajectories and CVD risk, with adjustment for metabolic comorbidities including diabetes and dyslipidemia, and subgroup analyses were conducted to explore potential effect modification by these conditions. Two trajectories were identified: high-stable (48%) and low-declining (52%). During follow-up, 497 participants (27.2%) developed CVD. Compared with the high-stable group, the low-declining group had a higher risk of CVD (Model 1: OR 1.27, 95% CI 1.00–1.60; Model 2: OR 1.28, 95% CI 1.01–1.63; Model 3: OR 1.35, 95% CI 1.05–1.72). Declining cognitive trajectories are associated with increased CVD risk in older adults. Longitudinal cognitive assessment may help identify high-risk individuals and inform early prevention strategies.