New research suggests that cognitive decline may begin years before a major cardiovascular disease (CVD) event occurs, offering important insights into the connection between heart health and brain function.

Researchers analyzed data from more than 19,000 older adults enrolled in the ASPREE (Aspirin in Reducing Events in the Elderly) study and its extension, ASPREE-XT. Participants, all age 65 or older and free of cardiovascular disease at enrollment, were followed for up to 11 years. During that time, nearly 2,000 participants experienced a cardiovascular event, including coronary heart disease, stroke, heart failure, or heart attack.

The study found that individuals who experienced a cardiovascular event during their follow-up showed measurable declines in cognitive function beginning three to eight years before the event occurred. Compared with matched participants who remained free of cardiovascular disease, those who experienced CVD demonstrated faster declines in global cognition, memory, processing speed, verbal fluency, and executive function.

Researchers observed similar patterns among participants who later experienced fatal coronary heart disease, stroke, or hospitalization for heart failure. However, the same trend was not seen among those who experienced a nonfatal heart attack, where cognitive trajectories more closely resembled those of participants without cardiovascular disease.

The findings suggest that cognitive changes may not simply be a consequence of cardiovascular disease but could share an underlying pathway that develops years before clinically-relevant outcomes occur. Researchers believe these results could help improve understanding of the relationship between cognitive health and cardiovascular disease and may inform future efforts to identify individuals at risk earlier.

The study highlights the importance of monitoring both heart and brain health as people age and underscores the close connection between cognitive function and cardiovascular well-being. 

The full publication, Cognitive Decline Preceding Incident Cardiovascular Events in Older Adults, was published in JAMA Network Open. Michael Ernst, clinical professor in the UI College of Pharmacy, is a contributing author.