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Left ventricular mass increase linked to elderly cognitive decline
16 June 2009
MedWire News: Left ventricular mass increase (LVMI) is linked to progressive cognitive decline in elderly individuals, regardless of blood pressure levels or degree of arterial stiffness, Italian study findings indicate.
Traditionally, age-associated cognitive decline has been attributed to neurodegenerative processes. However, this assumption has been challenged by evidence pointing to the presence of microvascular subcortical disease and hypertension being a risk factor for Alzheimer’s dementia.
To examine links between LVMI, a part of composite target organ damage in hypertension, and cognitive decline, Angelo Scuteri, from Istituto di Ricovero e Cura a Carattere Scientifico IRCCS in Rome, and colleagues studied 400 geriatric patients with an average age of 79 years.
Echocardiography was used to measure LVMI in line with the recommendations of the American Society of Echocardiography and normalized for body height to the allometric power of 2.7, with left ventricular hypertrophy defined as an LVMI >50 g/m2.7.
In addition, the Mini-Mental State Examination (MMSE) was administered to assess global cognitive function, with dementia defined as a score <21, and carotid–femoral pulse wave velocity gave an estimation of arterial stiffness.
Overall, 70.0% of patients had hypertension, 24.5% had diabetes, and 73.7% had left ventricular hypertrophy. Dividing patients into LVMI quartiles, there were no differences in hypertension or diabetes prevalence, or the presence of traditional cardiovascular risk factors.
Despite blood pressure being comparable across LVMI quartiles, there was a significant inverse trend in MMSE scores across LVMI quartiles, even after taking into account age, gender, traditional cardiovascular risk factors, and prevalent cardio- and cerebrovascular disease.
Multivariate analysis indicated that the highest LVMI quartile was independently associated with a 2.7-fold increased risk for dementia versus the lowest LVMI quartile. The finding was unaffected by adjustment for arterial stiffness, the team notes in the European Heart Journal.
They write: “Our study has...potential implication for clinical management of older hypertensive subjects. In fact, it has extensively been debated whether lowering blood pressure is the only goal of antihypertensive therapy or how blood pressure is lowered matters.
“Our observation favors the idea that the way we lower blood pressure is relevant in older subjects in order to preserve cognitive integrity and prevent disability.”
