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Library/Life Sciences Undergraduate Poster Competition 2020

Library/Life Sciences Undergraduate Poster Competition

2020-04-03

Cognitive Decline in Older Adults After Incident Coronary Heart Cognitive Decline in Older Adults After Incident Coronary Heart

Disease or After First Receipt of CABG Surgery or PCI Disease or After First Receipt of CABG Surgery or PCI

Jacqueline E. Kunzelman Brigham Young University - Provo, jacqueline.kunzelman@gmail.com

Evan L. Thacker Brigham Young University - Provo

Rachel M. Gabor Brigham Young University - Provo

Monica Scrobotovici Brigham Young University - Provo

Natalie J. Blades Brigham Young University - Provo

See next page for additional authors Follow this and additional works at: https://scholarsarchive.byu.edu/library_studentposters_2020

Part of the Life Sciences Commons

BYU ScholarsArchive Citation BYU ScholarsArchive Citation Kunzelman, Jacqueline E.; Thacker, Evan L.; Gabor, Rachel M.; Scrobotovici, Monica; Blades, Natalie J.; Longstreth, WT Jr.; Heckbert, Susan R.; Psaty, Bruce M.; Arnold, Alice M.; Fitzpatrick, Annette L.; Llewellyn, David J.; Kuźma, Elżbieta; Kamel, Hooman; Dhamoon, Mandip S.; Chaudhry, Sarwat I.; Dodson, John A.; Hedges, Dawson W.; Gale, Shawn D.; Erickson, Lance D.; and Brown, Bruce L., "Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of CABG Surgery or PCI" (2020). Library/Life Sciences Undergraduate Poster Competition 2020. 13. https://scholarsarchive.byu.edu/library_studentposters_2020/13

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Authors Authors Jacqueline E. Kunzelman, Evan L. Thacker, Rachel M. Gabor, Monica Scrobotovici, Natalie J. Blades, WT Longstreth Jr., Susan R. Heckbert, Bruce M. Psaty, Alice M. Arnold, Annette L. Fitzpatrick, David J. Llewellyn, Elżbieta Kuźma, Hooman Kamel, Mandip S. Dhamoon, Sarwat I. Chaudhry, John A. Dodson, Dawson W. Hedges, Shawn D. Gale, Lance D. Erickson, and Bruce L. Brown

This poster is available at BYU ScholarsArchive: https://scholarsarchive.byu.edu/library_studentposters_2020/13

Trajectoriesshowninthegraphsareadjustedforbaselinevaluesofsex,race,education,smoking,alcoholuse,betablockeruse,ACEinhibitoruse,bodymassindex,hypertension,systolicbloodpressure,chronickidneydisease,chronicobstructivepulmonarydisease,anemia,diabetes,atrialfibrillation,andheartfailure.

CognitiveDeclineinOlderAdultsafterIncidentCoronaryHeartDiseaseorafterFirstReceiptofCABGSurgeryorPCI

JacquelineEKunzelman1,EvanLThacker1,RachelMGabor1,MonicaScrobotovici1,NatalieJBlades1,WTLongstrethJr2,SusanRHeckbert2,BruceMPsaty2,AliceMArnold2,AnnetteLFitzpatrick2,DavidJLlewellyn3,ElżbietaKuźma3,HoomanKamel4,MandipSDhamoon5,SarwatIChaudhry6,JohnADodson7,DawsonWHedges1,ShawnDGale1,LanceDErickson1,BruceLBrown1

1BrighamYoungUniv,2UnivofWashington,3UnivofExeter,4WeillCornellMed,5MountSinaiSchofMed,6YaleUniv,7NYUSchoolMedicine

AdditionalResults

RationaleandResearchQuestions Results

Methods

Conclusions

•  Cardiovascularhealthanddiseaseareimportantdeterminantsofcognitivedecline•  Population-basedlongitudinalstudiesofthisissueareneeded•  Hypotheses:•  IncidentCHDleadstofasterlong-termcognitivedeclineinolderadults•  AmongolderadultswithCHD,treatmentwithCABGsurgeryorPCIleadstoslowerlong-termcognitivedecline

•  CardiovascularHealthStudy(CHS):population-basedlongitudinalcohortof5,888USadultsaged65+atenrollmentin1989-1992•  IncidentCHDisdefinedasdiagnosisofmyocardialinfarctionordefiniteangina,adjudicatedbycommittee•  RevascularizationproceduresincludedCABG(coronaryartery

bypassgraft)andPCI(percutaneouscoronaryintervention)•  Cognitivefunctionassessedannually•  Globalcognition:ModifiedMini-MentalStateExam(3MS)annually1990-1998(upto9times)

•  Linearmixedmodelstoestimateaverageratesofdeclinein3MSscoresbyCHDstatus(incidentornoCHD),adjustedfordemographics,healthbehaviors,physiologicalandclinicalcharacteristics• Weexcludedparticipantswithprevalentstrokeandcensoredthematincidentstroke

•  3MSanalysis(globalcognition)andincidentCHD:•  4,122olderadultswithnoCHD,398withincidentCHDduringameanof5.9yearsoffollow-up•  Model-predicted3MSscoredeclinedfasterafterincidentCHD,especiallyforCHDdiagnosedatage80orlater(Figure1andTable2)

•  3MSanalysis(globalcognition)andCABGsurgeryorPCI:•  1,183olderadultswithincidentCHD,118hadtheirfirstCABG/PCIduringameanof4.1yearsoffollow-up•  Model-predicted3MSscoredeclinedfasterafterfirstreceiptofCABG/PCI(Figure2andTable3)

•  OlderadultsdiagnosedwithincidentCHDexperiencedfasteraveragecognitivedeclinethanthosewithoutCHD•  TreatmentwithCABG/PCIdidnotslowcognitivedeclineamongolderadultswithCHD•  ThismaybeduetoadverseeffectsofCABG/PCIonbrainhealthorCABG/PCIrecipientshavingmoresevereCHD

Funding•  CHSisfundedbyNHLBI,NINDS,andNIA.Grantandcontractnumbersareavailableuponrequest.

Table2.Model-predicted5-yeardeclinesinmean3MSscorebyageandincidentCHDstatus Model-predicted5-yeardecline(95%CI)CHD 70to75yofage 75to80yofage 80to85yofage 85to90yofageNoCHDdiagnosedbeforeorduringthe5-yearinterval

-0.3(-0.6,0.0) 2.8(2.5,3.1) 5.9(5.4,6.3) 8.9(8.1,9.7)

IncidentCHDdiagnosedatbeginningofthe5-yearinterval

0.7(-0.6,1.9) 3.5(2.4,4.6) 7.9(6.3,9.4) 13.9(11.0,16.7)

Difference(incidentCHDminusnoCHD)

0.9(-0.3,2.2) 0.7(-0.4,1.8) 2.0(0.5,3.6) 5.0(2.1,7.8)

Table3.Model-predicted5-yeardeclinesinmean3MSscorebyageandCABG/PCIstatus

Model-predicted5-yeardecline(95%CI)CABG/PCI 70to75yofage 75to80yofage 80to85yofage 85to90yofageNoreceiptofCABG/PCI

beforeorduringthe5-

yearinterval

0.2(-0.6,1.0) 3.1(2.5,3.6) 6.0(5.0,6.8) 8.8(7.3,10.3)

FirstreceiptofCABG/PCI

atbeginningofthe5-

yearinterval

1.2(-1.4,3.8) 5.4(3.4,7.4) 9.6(6.3,13.0) 13.8(8.6,19.1)

Difference(CABG/PCI

minusnoCABG/PCI)

1.0(-1.6,3.5) 2.3(0.3,4.4) 3.7(0.3,7.1) 5.0(-0.3,10.4)

Figure1.3MStrajectoriesbyageandCHD Figure2.3MStrajectoriesbyageandCABG/PCI

Characteristic

ParticipantsdiagnosedwithincidentCHDduringfollow-up

(N=398)

ParticipantsnotdiagnosedwithincidentCHDduring

follow-up(N=3,724)

ParticipantswithCHDwhohadfirstreceiptofCABG/PCI

duringfollow-up(N=118)

ParticipantswithCHDwhodidnothaveCABG/PCIduring

follow-up(N=1,065)

Age,y,mean(SD) 73.4(5.1) 72.8(5.3) 72.0(4.2) 74.1(5.7)

Male,% 52.0 37.6 56.8 48.0

Blackrace,% 11.1 15.1 14.4 13.2

Yearsofeducationthrough12th

grade,mean(SD)

11.0(2.0) 11.0(1.9) 11.3(1.7) 10.8(2.1)

Anyeducationbeyond12thgrade,% 44.0 44.6 44.9 38.1

Formersmoking,% 46.0 39.9 48.3 44.5

Currentsmoking,% 10.6 12.2 14.4 11.1

Anycurrentalcoholuse,% 49.3 51.8 50.9 47.9

Amongdrinkers:drinks/week,mean

(SD)

4.7(8.2) 5.2(8.6) 3.4(5.3) 4.3(7.5)

Beta-blockeruse,% 11.8 9.1 14.4 21.7

Angiotensinconvertingenzyme

inhibitoruse,%

6.3 6.2 5.1 7.9

Systolicbloodpressure,mmHg,mean

(SD)

141.0(21.6) 135.6(21.4) 136.1(20.1) 137.0(22.5)

Bodymassindex,kg/m2,mean(SD) 27.0(4.6) 26.5(4.7) 27.1(4.2) 27.0(4.8)

Chronickidneydisease,% 41.7 35.5 32.2 45.6

Chronicobstructivepulmonary

disease,%

16.3 12.0 15.3 17.0

Anemia,% 7.3 7.5 5.9 8.4

Diabetes,% 18.3 12.8 20.3 18.9

Hypertension,% 63.6 54.5 57.6 64.0

Heartfailure,% 2.8 1.6 2.5 8.3

Atrialfibrillation,% 1.8 2.2 1.7 2.6

Table1.Participantbaselinecharacteristics