European Heart Journal Advance Access originally published online on April 30, 2009
European Heart Journal 2009 30(12):1525-1529; doi:10.1093/eurheartj/ehp133
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Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure
1 UO Geriatria, INRCA/IRCCS, Via Cassia 1167, 00189 Rome, Italy
2 Department of Cardiology, INRCA/IRCCS, Rome, Italy
3 Second Faculty of Medicine, University of Rome ‘La Sapienza’, Rome, Italy
4 IRCCS Neuromed, Pozzilli, Italy
Received 18 December 2008; revised 5 March 2009; accepted 12 March 2009; online publish-ahead-of-print 30 April 2009.
* Corresponding author. Tel: +39 06 30 34 21, Fax: +39 06 30 36 28 96, Email: angeloelefante{at}interfree.it
Aims: Left ventricular (LV) mass increase is considered part of composite target organ damage in hypertension and an independent risk factor for cardiovascular (CV) events. This study was designed to explore whether left ventricular mass index (LVMI) is associated with cognitive decline and dementia in elderly subjects, independently of blood pressure (BP) levels.
Methods and results: Four hundred subjects (mean age 79 ± 6 years) were studied. Left ventricular mass was measured echocardiographically in accordance with American Society of Echocardiography and normalized for body height to the 2.7 (LVMI). Global cognitive function was evaluated with the mini-mental state examination (MMSE) (maximum score 30). Dementia was defined as an MMSE score <21. Arterial stiffness was evaluated as carotid–femoral pulse wave velocity by Complior®. Prevalence of hypertension was 70% and diabetes mellitus was diagnosed in 25%. No significant differences in traditional CV risk factors were observed across LVMI quartiles. Mini-mental state examination showed an inverse trend across LVMI quartiles (the higher the LVMI, the lower the MMSE, P for trend <0.05); systolic and diastolic BP levels were not different across LVMI quartiles. In multivariable logistic regression models, including age, sex, BP levels, and use of antihypertensive drugs as covariates, the highest LVMI was found to be independently associated with a two-fold higher likelihood of having dementia. The association persisted significant even after adjustment for arterial stiffness.
Conclusion: In elderly subjects, LVMI is associated with a progressive cognitive decline. This association is independent of BP levels and/or large artery stiffness.
Key Words: Left ventricular mass • Blood pressure • Dementia • Cognition • Arterial stiffness • Pulse wave velocity • Elderly