Coronary Calcification and Cognitive Decline in ELSA-Brasil
CORONARY AND AORTIC CALCIFICATION AND COGNITIVE PERFORMANCE CHANGE IN ELSA-BRASIL: A LONGITUDINAL STUDY
Igor Vasconcelos Barros Croemberg1, Jesiane Ferreira Pedrosa1, Daniel Bos1, Luana Giatti Gonçalves1, Sandro Maria Barreto1
- Postgraduate program in Public Health, Medical School and Clinical Hospital (ESMEC), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
OPEN ACCESS
PUBLISHED: 31 March 2025
CITATION: CRONEMBERGER, Igor Vasconcelos Barros et al. CORONARY AND AORTIC CALCIFICATION AND COGNITIVE PERFORMANCE CHANGE IN ELSA-BRASIL: A LONGITUDINAL STUDY. Medical Research Archives, [S.l.], v. 13, n. 3, mar. 2025. Available at: <https://esmed.org/MRA/mra/article/view/6314>.
COPYRIGHT: © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI: https://doi.org/10.18103/mra.v13i3.6314
ISSN 2375-1924
Abstract
Backgrounds and aims: Evidence of the association between arterial calcification and cognitive performance is scarce. The aim of this study was to evaluate the association between coronary artery calcification (CAC), thoracic aorta calcification (TAC), and cognitive performance in Brazilian adults over four years of follow-up.
Methods: Data from participants aged 55 years and older from the ELSA-Brasil study were analyzed. Cognitive tests were applied in all visits, but only participants aged ≥55 years old at visit 2; therefore, 1,161 participants were excluded. Participants with a history of stroke were also excluded from the analyses (N=24). Thus, our final sample was restricted to participants from Belo Horizonte center aged ≥55 years old who underwent complete assessments at baseline and at follow-up visits (N=1,331).
Results: The global cognitive score, represented by G-factor, was associated with worse cognitive performance in participants who performed all the tests. G-factor was the first factor and explained 64% of the total variance of cognitive tests. This proportion is a typical value of variance explained by g-factor.
Conclusion: The presence of any calcification in the coronary artery and thoracic aorta was associated with worse cognitive performance in Brazilian adults, over about four years follow-up.
Keywords
- Coronary artery calcification
- Thoracic aorta calcification
- Cognitive performance
- Longitudinal study
- ELSA-Brasil
Introduction
One of the hallmarks of atherosclerosis is calcification, which can be quantified using computed tomography (CT) scans by Agatston score. A high coronary arteries calcification (CAC) score is a well-established independent marker of risk of cardiovascular events, cardiac mortality, and all-cause mortality. Calcification in the thoracic aorta (TAC), on the other hand, has not undoubtedly demonstrated prognostic value for cardiac events, independent of risk factors and CAC although it seems to be associated with non-cardiovascular disease-related mortality, probably through a pathway that is unrelated to atherosclerosis per se (most likely, through other mechanisms).
In total, 2,516 individuals were screened. Cognitive tests were applied in all visits, but only participants aged ≥55 years old at visit 2; therefore, 1,161 participants were excluded. Participants with a history of stroke were also excluded from the analyses (N=24). Thus, our final sample was restricted to participants from Belo Horizonte center aged ≥55 years old who underwent complete assessments at baseline and at follow-up visits (N=1,331).
CORONARY ARTERY AND THORACIC AORTA CALCIUM SCORES
All participants in our sample underwent CT scans of the thoracic aorta and coronary arteries, which were performed only at baseline. The Agatston score was calculated for each participant based on the number of calcified lesions.
Statistical analysis
Linear regression models with random intercepts were used to assess the association between the presence of calcification and cognitive performance. The models were adjusted for age, sex, education, and other potential confounders.
Results
After considering all covariates in the analyses, we found that higher CAC scores were associated with worse global cognitive performance in verbal fluency tests, and Trail B test scores were also statistically significant. We observed statistically significant associations between both medium and higher DTAC and worse cognitive performance in Trail B test performance and global cognitive scores.
Discussion
In the cohort of middle-aged and older adults, we examined whether calcification in the coronary artery and the thoracic aorta was associated with cognitive performance in about four-year follow-up. Results indicate that the presence of any calcification in the descending aorta, both in the coronary arteries and thoracic aorta, was associated with worse cognitive performance in verbal fluency at baseline, with indication that it changed the pace of cognitive decline in these domains in the following year.
Conclusion
This study adds to the current evidence of calcification in total thoracic aorta and its associations (separately) with cognitive function over time. The mere presence of calcification in any of the analyzed vascular beds did not accelerate cognitive decline over the study time.
Conflict of interest
Authors have no conflict of interest to declare.
References
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