Associação da calcificação nas artérias coronárias e aorta com a performance cognitiva no ELSA-Brasil: um estudo longitudinal

Abstract

INTRODUCTION: Arterial calcification assessed by computed tomography provides reliable estimates of subclinical atherosclerosis. The presence of calcification and the severity of calcification in coronary arteries and other vascular beds, but more robustly in the coronary arteries, has been widely associated with cardiovascular and even non-cardiovascular clinical outcomes. Atherosclerosis is thought to be associated with cognitive decline and with an increased risk of dementia. However, evidence of an association between arterial calcification and worse cognitive performance comes, for the most part, from cross-sectional studies and, even so, with some conflicting results.

OBJECTIVES: To investigate whether the presence and severity of calcification in the coronary artery (CAC), total thoracic aorta (TAC) and its segments [ascending thoracic aorta (ATAC), aortic arch (AAC) and descending thoracic aorta (DTAC)] are longitudinally associated with changes in cognitive performance at 4 years of follow-up in Brazilian adults from the ELSA-Brasil cohort.

METHODS: A longitudinal analysis was performed with approximately 4 years of follow-up between arterial calcification and cognitive performance of 1,331 individuals (mean age 62.4 years) from the ELSA-Brasil cohort in the state of Minas Gerais who participated in waves 2 (2012-2014) and 3 (2017-2019). The explanatory variables (CAC, TAC, ATAC, DTAC) were obtained by computed tomography during visit 2 and analyzed dichotomously (present or absent) and in levels (0, 1-399UA and ≥ 400UA); the response variable (cognitive performance) was evaluated in tests (B trails test, verbal fluency and memory test) applied in visits 2 and 3. Sociodemographic parameters (gender, education, race/color), behavioral (smoking and leisure-time physical activity) and clinical parameters (hypertension, diabetes and body mass index)] were ascertained through face-to-face interviews in visit 2. For the statistical analysis, linear regression models with mixed effects were used.

RESULTS: We observed that, regardless of cardiovascular risk factors, the presence of calcification in the descending thoracic aorta, but not in other vessel beds, was associated with worse performance in verbal fluency tests, in the Trail B test and in Factor G at baseline. When arterial calcification was analyzed by levels, there were associations between CAC≥ 400UA and worse performance in the Factor G and associations between TAC≥ 400UA and AAC≥ 400UA and worse performance in the Trail B test. Besides that, we found a graded association between greater calcifications in levels of DTAC and worse performance in the verbal fluency tests and test of trails B and factor G. Although there was a positive association between DTAC≥ 400UA and performance in the memory test in the baseline, DTAC≥ 400UA was also associated with worse longitudinal performance in this cognitive domain at follow-up, as well as worse global cognitive performance at the end of the study period.

CONCLUSION: The results suggest that calcification in different vascular beds is distinctly associated with worse cognitive performance in different cognitive domains, regardless of cardiovascular risk factors. In addition, higher levels of calcification in the descending thoracic aorta artery predicted greater speed in cognitive decline over time.