Relation of Cognitive Reserve Indicator to Heart Disease and Cardiac Structure and Function: A Large Community‐Based Longitudinal Study

Abstract

Background High cognitive reserve (CR) has been related to lower dementia risk, but its association with heart disease (HD) is unknown. We aimed to explore the relation of CR to HD and cardiac structure and function. Methods and Results Within the UK Biobank, 349 907 HD‐free participants were followed up. A composite CR indicator involving education/occupation attainment/television viewing time/confiding frequency/social connection frequency/variety of leisure activities was generated, and further categorized into low/moderate/high levels. Incident HD, including coronary HD, cardiac arrhythmia, and heart failure, was ascertained on the basis of medical records. During the follow‐up, a subsample (n=31 182) underwent cardiac magnetic resonance imaging to assess ventricular structure and function. Data were analyzed using Cox regression, Laplace regression, and linear regression. Compared with low CR, the hazard ratio and 95% CI of any HD for high CR was 0.78 (0.75–0.80) (including 0.68 [0.66–0.71] for coronary HD, 0.91 [0.87–0.95] for cardiac arrhythmia, and 0.63 [0.58–0.68] for heart failure). Furthermore, high CR was associated with delayed HD onset by 1.59 (95% CI, 1.37–1.82) years compared with low CR. In cardiac magnetic resonance imaging data analysis, compared with low CR, high CR was associated with larger left ventricular end‐diastolic volume (β, 0.13 [95% CI, 0.09–0.17]), left ventricular end‐systolic volume (β, 0.05 [95% CI, 0.01–0.10]), left ventricular stroke volume (β, 0.16 [95% CI, 0.12–0.21]), and left ventricular ejection fraction (β, 0.08 [95% CI, 0.03–0.13]). Conclusions High CR is associated with favorable HD health. Our findings suggest that the beneficial effect of CR is not limited to dementia but also HD.