Higher Adiposity Is Associated With Slower Cognitive Decline in Hypertensive Patients: Secondary Analysis of the China Stroke Primary Prevention Trial

J Am Heart Assoc. 2017 Oct 10;6(10):e005561. doi: 10.1161/JAHA.117.005561.

Abstract

Background: Obesity is a risk factor for many diseases. However, the potential association between adiposity and cognitive decline in hypertensive patients is inconclusive. We performed a secondary data analysis of the CSPPT (China Stroke Primary Prevention Trial) to examine whether adiposity is correlated with longitudinal cognitive performance in hypertensive adults.

Methods and results: The analysis included 16 791 patients in the CSPPT who received at least 2 cognitive assessments by the Mini-Mental State Examination (MMSE) during the follow-up (median, 4.5 years; interquartile range, 4.2-4.8 years). Outcomes included changes in MMSE scores and cognitive impairment (defined as MMSE score less than education-specific cutoff point). A marked reduction in MMSE scores at the final (compared with at the 1-year) follow-up was apparent in both men (n=4838; mean [SD] score, 0.41 [3.62]) and women (n=7190; mean [SD] score, 1.07 [4.61]; both P<0.001). Analysis using a mixed-effects model revealed an association between higher body mass index with less MMSE decline, even after controlling for demographics and comorbidities (men, β=0.0134 [SE, 0.0036]; women, β=0.0133 [SE, 0.0034]; both P<0.001). A total of 1037 men (15.3%) and 3317 women (33.1%) developed cognitive impairment. In multivariable Cox regression analyses, being obese in men (11.3% versus 18.0%; hazard ratio, 0.75; 95% confidence interval, 0.60-0.94) and women (30.1% versus 36.5%; hazard ratio, 0.82; 95% confidence interval, 0.74-0.91) was a protective factor against cognitive impairment compared with normal body mass index.

Conclusions: Higher adiposity is independently associated with slower cognitive decline in Chinese hypertensive adults.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885 CSPPT.

Keywords: adiposity; body mass index; cognitive decline; hypertension; waist circumference.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adiposity*
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure* / drug effects
  • Body Mass Index
  • Chi-Square Distribution
  • China / epidemiology
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cognition Disorders / psychology*
  • Cognition*
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Hypertension / physiopathology*
  • Linear Models
  • Longitudinal Studies
  • Male
  • Mental Status and Dementia Tests
  • Middle Aged
  • Multivariate Analysis
  • Nonlinear Dynamics
  • Obesity / diagnosis
  • Obesity / epidemiology
  • Obesity / physiopathology*
  • Primary Prevention / methods
  • Proportional Hazards Models
  • Protective Factors
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / prevention & control
  • Time Factors
  • Waist Circumference

Substances

  • Antihypertensive Agents

Associated data

  • ClinicalTrials.gov/NCT00794885