Risk factors for vascular dementia in patients with nonvalvular atrial fibrillation: a case-control study

doi:10.11958/20212846

Abstract

Abstract:

Objective To investigate the risk factors of vascular dementia in patients with nonvalvular atrial fibrillation, and to evaluate the relationship between different anticoagulants and vascular dementia in patients with atrial fibrillation. Methods A case-control study was conducted in 66 patients with nonvalvular atrial fibrillation and vascular dementia (the case group). The control group included 132 patients with nonvalvular atrial fibrillation and without vascular dementia. Data of age, sex, body mass index (BMI), education level, smoking and other general conditions including disease history of diabetes, hypertension, angina pectoris, chronic obstructive pulmonary disease (COPD), hyperthyroidism, hypothyroidism, myocardial infarction, dyslipidemia and anticoagulant drug use were compared between the two groups. Results There were no significant differences in age, gender, incidence of obesity and average education years between the two groups (P>0.05). The proportion of smoking and utilization rate of warfarin was significantly higher in the case group than that in the control group (P<0.05). The incidence of hypertension, diabetes, angina pectoris and dyslipidemia were significantly higher in the case group than those in the control group (P<0.05). Logistic regression analysis showed that the risk of vascular dementia was lower in patients taking rivaroxaban anticoagulant therapy than that in patients taking warfarin (OR=0.480, 95%CI: 0.244-0.944). Diabetes mellitus (OR=2.117, 95%CI: 1.080-4.149), hypertension (OR=2.224, 95%CI: 1.109-4.461), smoking (OR=2.269, 95%CI: 1.148-4.488), dyslipidemia (OR=2.045, 95%CI: 1.037-4.032) and history of angina pectoris (OR=2.336, 95%CI: 1.165-4.682) were risk factors for vascular dementia in patients with nonvalvular atrial fibrillation (P<0.05). Conclusion Compared with warfarin, rivaroxaban anticoagulant therapy is a protective factor for vascular dementia in patients with nonvalvular atrial fibrillation, while diabetes, hypertension, smoking, dyslipidemia and history of angina are risk factors for vascular dementia in patients with nonvalvular atrial fibrillation.

Key words: atrial fibrillation, dementia, vascular, rivaroxaban, risk factors

CLC Number:

R541.7

Figures/Tables 2

References 28

[1]	KANG F, MA Y, CAI A, et al. Meta-analysis evaluating the efficacy and safety of low-intensity warfarin for patients >65 years of age with non-valvular atrial fibrillation[J]. Am J Cardiol, 2021, 142:74-82. doi: 10.1016/j.amjcard.2020.12.001.
[2]	FAUCHIER L, PHILIPPART R, CLEMENTY N, et al. How to define valvular atrial fibrillation?[J]. Arch Cardiovasc Dis, 2015, 108(10):530-539. doi: 10.1016/j.acvd.2015.06.002.
[3]	HEALEY J S, AMIT G, FIELD T S. Atrial fibrillation and stroke:how much atrial fibrillation is enough to cause a stroke?[J]. Curr Opin Neurol, 2020, 33(1):17-23. doi: 10.1097/WCO.0000000000000780.
[4]	KIM D, YANG P S, YU H T, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation:data from a population-based cohort[J]. Eur Heart J, 2019, 40(28):2313-2323. doi: 10.1093/eurheartj/ehz386.
[5]	DAGRES N, CHAO T F, FENELON G, et al. European Heart Rhythm Association(EHRA)/Heart Rhythm Society(HRS)/Asia Pacific Heart Rhythm Society(APHRS)/Latin American Heart Rhythm Society(LAHRS)expert consensus on arrhythmias and cognitive function:what is the best practice?[J]. Europace, 2018, 20(9):1399-1421. doi: 10.1093/europace/euy046.
[6]	BUNCH T J. Atrial fibrillation and dementia[J]. Circulation, 2020, 142(7):618-620. doi: 10.1161/CIRCULATIONAHA.120.045866.
[7]	COLLINS P, LEWIN A, VINCZE IRVING N, et al. Atrial fibrillation patients on warfarin and their transition to direct oral anticoagulants[J]. Crit Pathw Cardiol, 2021, 20(2):103-107. doi: 10.1097/HPC.0000000000000251.
[8]	ALBERTS M, CHEN Y W, LIN J H, et al. Risks of stroke and mortality in atrial fibrillation patients treated with rivaroxaban and warfarin[J]. Stroke, 2020, 51(2):549-555. doi: 10.1161/STROKEAHA.119.025554.
[9]	FRIBERG L, ROSENQVIST M. Less dementia with oral anticoagulation in atrial fibrillation[J]. Eur Heart J, 2018, 39(6):453-460. doi: 10.1093/eurheartj/ehx579.
[10]	BRIEN J T, THOMAS A. Vascular dementia[J]. Lancet, 2015, 386(10004):1698-1706. doi: 10.1016/S0140-6736(15)00463-8.
[11]	翁映虹, 黄坚红. 血管性痴呆的定义及诊断进展[J]. 广东医学, 2010, 31(14):1881-1882.
	WEN Y H, HUANG J H. Definition and diagnosis of vascular dementia[J]. Guangdong Med J, 2010, 31(14):1881-1882. doi: 10.3969/j.issn.1001-9448.2010.14.047.
[12]	KALARIA R N. The pathology and pathophysiology of vascular dementia[J]. Neuropharmacology, 2018, 134(Pt B):226-239. doi: 10.1016/j.neuropharm.2017.12.030.
[13]	ALDRUGH S, SARDANA M, HENNINGER N, et al. Atrial fibrillation,cognition and dementia:A review[J]. J Cardiovasc Electrophysiol, 2017, 28(8):958-965. doi: 10.1111/jce.13261.
[14]	CHOPARD R, PIAZZA G, GALE S A, et al. Dementia and atrial fibrillation:pathophysiological mechanisms and therapeutic implications[J]. Am J Med, 2018, 131(12):1408-1417. doi: 10.1016/j.amjmed.2018.06.035.
[15]	李瑞龄, 赵志强. 松弛素在心房颤动中的应用研究进展[J]. 天津医药, 2021, 49(4)441-444.
	LI R L, ZHAO Z Q. Research progress of relaxin in atrial fibrillation[J]. Tianjin Med J, 2021, 49(4):441-444. doi: 10.11958/20201643.
[16]	KVASNICKA T, MALIKOVA I, ZENAHLIKOVA Z, et al. Rivaroxaban-metabolism,pharmacologic properties and drug interactions[J]. Curr Drug Metab, 2017, 18(7):636-642. doi: 10.2174/1389200218666170518165443.
[17]	PETERSON E D, ASHTON V, CHEN Y W, et al. Comparative effectiveness,safety,and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation[J]. Am Heart J, 2019, 212:113-119. doi: 10.1016/j.ahj.2019.02.001.
[18]	KIM D, YANG P S, JANG E, et al. Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation[J]. Europace, 2021, 23(2):184-195. doi: 10.1093/europace/euaa192.
[19]	JACOBS V, MAY H T, BAIR T L, et al. Long-term population-based cerebral ischemic event and cognitive outcomes of direct oral anticoagulants compared with warfarin among long-term anticoagulated patients for atrial fibrillation[J]. Am J Cardiol, 2016, 118(2):210-214. doi: 10.1016/j.amjcard.2016.04.039.
[20]	BAUERSACHS R, ZANNAD F. Rivaroxaban:A new treatment paradigm in the setting of vascular protection?[J]. Thromb Haemost, 2018, 118(S01):S12-S22. doi: 10.1055/s-0038-1636530.
[21]	WALKER K A, POWER M C, GOTTESMAN R F. Defining the relationship between hypertension,cognitive decline,and dementia:A review[J]. Curr Hypertens Rep, 2017, 19(3):24. doi: 10.1007/s11906-017-0724-3.
[22]	BIESSELS G J, DESPA F. Cognitive decline and dementia in diabetes mellitus:mechanisms and clinical implications[J]. Nat Rev Endocrinol, 2018, 14(10):591-604. doi: 10.1038/s41574-018-0048-7.
[23]	黄丽琴. 血管性痴呆和2型糖尿病关系的研究进展[J]. 中风与神经疾病杂志, 2021, 38(6):570-573.
	HUANG L Q. Research progress on the relationship between vascular dementia and type 2 diabetes mellitus[J]. Journal of Apoplexy and Nervous Diseases, 2021, 38(6):570-573. doi: 10.19845/j.cnki.zfysjjbzz.2021.0154.
[24]	HAMED S A. Brain injury with diabetes mellitus:evidence,mechanisms and treatment implications[J]. Expert Rev Clin Pharmacol, 2017, 10(4):409-428. doi: 10.1080/17512433.2017.1293521.
[25]	HELMAN A M, MURPHY M P. Vascular cognitive impairment:Modeling a critical neurologic disease in vitro and in vivo[J]. Biochim Biophys Acta, 2016, 1862(5):975-982. doi: 10.1016/j.bbadis.2015.12.009.
[26]	邓娟, 周华东, 李敬诚, 等. 吸烟与老年性痴呆关系的研究[J]. 重庆医学, 2006, 35(10):921-923.
	DENG J, ZHOU H D, LI J C, et al. Study of cigarette smoking and risk of dementia[J]. Chongqing Medicine, 2006, 35(10):921-923. doi: 10.3969/j.issn.1671-8348.2006.10.028.
[27]	GRAYSON L, THOMAS A J. Smoking,nicotine and dementia[J]. Maturitas, 2012, 72(1):4-5. doi: 10.1016/j.maturitas.2012.01.020.
[28]	APPLETON J P, SCUTT P, SPRIGG N, et al. Hypercholesterolaemia and vascular dementia[J]. Clin Sci(Lond), 2017, 131(14):1561-1578. doi: 10.1042/CS20160382.