View the session Strategies towards personalized risk stratification – available on demand
Targeting cardiovascular risk factors is not just good for the heart but also the brain. These are the potential implications from this Danish study reported at EAS 2020 today. The findings were discussed in the session – Strategies towards for personalized risk stratification – and simultaneously published in The European Heart Journal (1).
Already over 50 million people world-wide have dementia (2). This number is rising as populations age and younger age mortality declines, and is likely to triple by 2050 (3). Dementia imposes a high burden not just on the individual, family and carers but also society as a whole. Already in 2015 dementia cost the global economy more than US$800 billion (2) and there are no available curative treatments.
Yet there is evidence to suggest that up to one-third of dementia may be preventable. Indeed, the 2017 Lancet Commission on dementia prevention highlighted 12 potentially modifiable risk factors, i.e. education level, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury, and air pollution, which together account for around 40% of worldwide dementias (3). A risk score for identifying high-risk individuals for intensive targeted intervention to prevent the onset of dementia could have important impact. This is very much in line with SCORE risk charts for cardiovascular disease prevention, central to the 2019 ESC/EAS lipid guidelines (4).
Using data from 61,664 people in two prospective general population studies, the Copenhagen General Population Study and the Copenhagen City Heart Study, researchers developed 10-year absolute risk scores for all-cause dementia and Alzheimer’s disease. These risk scores were based on both vascular risk factors and genetics, given that the genetic contribution to dementia is recognised and substantial.
In both men and women, the risk of dementia increased with age and an increasing number of genetic and cardiovascular risk factors. The modifiable risk factors for all-cause dementia most relevant (i.e. with the highest hazard ratios) for women were diabetes, smoking and low education, and for men low physical activity also contributed. Together with genetic risk factors (APOE genotype, GWAS risk alleles), these were incorporated in the 10-year risk charts.
The highest 10-year absolute risk of all-cause dementia was in smoking women with diabetes, low education, APOE e44 genotype and a high GWAS risk allele score, ranging from 6% to those aged 50-59 years to 66% in the highest age group (>80 years). Risk was similar albeit slightly lower in men across the ages (ranging from 5% to 60%). Importantly, a healthy cardiovascular lifestyle halved the risk of dementia even in those individuals with highest genetic risk.
These findings have important implications for reducing the burden of this costly and devastating disease. The use of these risk charts would enable high-risk individuals to be identified early and targeted with early intensive intervention against cardiovascular risk factors. Risk charts for dementia therefore have the potential to reduce the burden of this costly and devastating disease.
Dr Ida Jul Rasmussen (Rigshospitalet, Copenhagen University Hospital; Herlev and Gentofte Hospital; and University of Copenhagen, Denmark) discusses the findings of the study in this video.
Senior author Professor Ruth Frikke-Schmidt (University of Copenhagen, Denmark) discusses the key message from this study in this video.
- Ida Juul Rasmussen, Katrine Laura Rasmussen, Børge G. Nordestgaard, Anne Tybjærg-Hansen, Ruth Frikke-Schmidt. Impact of cardiovascular risk factors and genetics on 10-year absolute risk of dementia: risk charts for targeted prevention. European Heart Journal 2020; doi:10.1093/eurheartj/ehaa695. Available at https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehaa695
- Dementia Statistics Hub. https://www.dementiastatistics.org/statistics-about-dementia/
- Livingston G, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020;396:413-446.
- Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-188.