Increasing cardiovascular disease risk predicts faster cognitive decline: A Bayesian analysis of a cohort of adults in rural West Texas

BACKGROUND: Cardiovascular disease (CVD) is a major risk factor for cognitive decline and dementia. We examined whether a higher atherosclerotic cardiovascular disease (ASCVD) risk is associated with faster cognitive decline in Project FRONTIER, a rural cohort. METHODS: Participants were aged ≥40 years without baseline CVD and completed two study visits. Primary outcomes were the RBANS Total Score and its domains; secondary outcomes were Executive Interview 25, verbal fluency, Clock Drawing Test (CLOX), and Trail Making Test (TMT) A and B. Primary exposure was the 10-year ASCVD risk per AHA PREVENT equations. We fitted Bayesian mixed-effects models to estimate the interaction between time (in years) and ASCVD risk, adjusting for covariates using brms package in R. RESULTS: We analyzed data of 383 participants (age 57.74 ± 11.4 years; 75.5 % female; 59.8 % Hispanic; median follow-up 3.00 years, IQR: 2.67-3.64). The time×ASCVD risk interaction for RBANS Total was credibly negative (β = -1.22 points/year per 10 % higher risk, 95 % CrI -1.87 to -0.58). Strongest domain-specific effects were for attention (β = -1.25; 95 % CrI -2.14 to -0.37) and delayed memory (β = -1.36; 95 % CrI -2.16 to -0.05). CLOX suggested a credibly negative interaction (β = -0.39; 95 % CrI -0.62 to -0.16), and TMT-A showed a credibly positive interaction (β = +2.85 s/year; 95 % CrI 1.28 to 4.41). DISCUSSION: In this rural cohort, a higher 10-year ASCVD risk was associated with faster decline in global cognition, particularly attention and delayed memory, supporting the potential value of cardiovascular risk monitoring and modification to preserve cognitive function.