Cardiovascular Diseases in ∼30,000 Patients in the Swedish Dementia Registry

Article type: Research Article

Authors: Cermakova, Pavla^{a; b; *} | Johnell, Kristina^c | Fastbom, Johan^c | Garcia-Ptacek, Sara^{d; e} | Lund, Lars H.^{f; g} | Winblad, Bengt^{a; e} | Eriksdotter, Maria^{d; e} | Religa, Dorota^{a; e}

Affiliations: [a] Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden | [b] International Clinical Research Center and St.Anne‘s University Hospital, Brno, Czech Republic | [c] Karolinska Institutet and Stockholm University, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Aging Research Center, Stockholm, Sweden | [d] Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Huddinge, Sweden | [e] Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden | [f] Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden | [g] Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

Correspondence: [*] Correspondence to: Pavla Cermakova, MD, Karolinska Institutet, Centrum for Alzheimer Research, Division for Neurogeriatrics, Novum, Blickagången 6, 141 57 Huddinge, Sweden. Tel.: +46 (8)58589397; Fax: +46 (8)58585470; [email protected]

Abstract: Background: Cardiovascular diseases are leading causes of death and patients with dementia are often affected by them. Objective: Investigate associations of cardiovascular diseases with different dementia disorders and determine their impact on mortality. Methods: This study included 29,630 patients from the Swedish Dementia Registry (mean age 79 years, 59% women) diagnosed with Alzheimer’s disease (AD), mixed dementia, vascular dementia, dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), frontotemporal dementia (FTD), or unspecified dementia. Records of cardiovascular diseases come from the Swedish National Patient Register. Multinomial logistic regression and cox proportional hazard models were applied. Results: Compared to AD, we found a higher burden of all cardiovascular diseases in mixed and vascular dementia. Cerebrovascular diseases were more associated with DLB than with AD. Diabetes mellitus was less associated with PDD and DLB than with AD. Ischemic heart disease was less associated with PDD and FTD than AD. All cardiovascular diseases predicted death in patients with AD, mixed, and vascular dementia. Only ischemic heart disease significantly predicted death in DLB patients (HR = 1.72; 95% CI = 1.16–2.55). In PDD patients, heart failure and diabetes mellitus were associated with a higher risk of death (HR = 3.06; 95% CI = 1.74–5.41 and HR = 3.44; 95% CI = 1.31–9.03). In FTD patients, ischemic heart disease and atrial fibrillation or flutter significantly predicted death (HR = 2.11; 95% CI = 1.08–4.14 and HR = 3.15; 95% CI = 1.60–6.22, respectively). Conclusion: Our study highlights differences in the occurrence and prognostic significance of cardiovascular diseases in several dementia disorders. This has implications for the care and treatment of the different dementia disorders.

Keywords: Alzheimer’s disease, cardiovascular diseases, dementia, mortality

DOI: 10.3233/JAD-150499

Journal: Journal of Alzheimer's Disease, vol. 48, no. 4, pp. 949-958, 2015