Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry

Author:

Dove Abigail1ORCID,Guo Jie1ORCID,Marseglia Anna2ORCID,Fastbom Johan1ORCID,Vetrano Davide Liborio13ORCID,Fratiglioni Laura13,Pedersen Nancy L4ORCID,Xu Weili15ORCID

Affiliation:

1. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Tomtebodavägen 18A, Solna SE-17165 , Sweden

2. Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet , Blickagången 16, Huddinge SE-14183 , Sweden

3. Stockholm Gerontology Research Center , Sveavägen 115, Stockholm SE-11346 , Sweden

4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Nobel väg 12A, Solna SE-17165 , Sweden

5. School of Public Health, Department of Epidemiology and Biostatistics, Tianjin Medical University , 22 Qi Xiang Tai Road, Tianjin , China

Abstract

Abstract Aims Cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke, are established risk factors for dementia, but their combined impact has been investigated only recently. This study aimed to examine the association between mid- and late-life cardiometabolic multimorbidity and dementia and explore the role of genetic background in this association. Methods and results Within the Swedish Twin Registry, 17 913 dementia-free individuals aged ≥60 were followed for 18 years. CMDs [including age of onset in mid (60) or late (≥60) life] and dementia were ascertained from medical records. Cardiometabolic multimorbidity was defined as having ≥2 CMDs. Cox regression was used to estimate the CMD–dementia association in (i) a classical cohort study design and (ii) a co-twin study design involving 356 monozygotic and dizygotic pairs. By comparing the strength of the association in the two designs, the contribution of genetic background was estimated. At baseline, 3,312 (18.5%) participants had 1 CMD and 839 (4.7%) had ≥2 CMDs. Over the follow-up period, 3,020 participants developed dementia. In the classic cohort design, the hazard ratio (95% confidence interval) of dementia was 1.42 (1.27–1.58) for 1 CMD and 2.10 (1.73–2.57) for ≥2 CMDs. Dementia risk was stronger with mid-life as opposed to late-life CMDs. In the co-twin design, the CMD–dementia association was attenuated among monozygotic [0.99 (0.50–1.98)] but not dizygotic [1.55 (1.15–2.09)] twins, suggesting that the association was in part due to genetic factors common to both CMDs and dementia. Conclusion Cardiometabolic multimorbidity, particularly in mid-life, is associated with an increased risk of dementia. Genetic background may underpin this association.

Funder

Swedish Twin Registry

Karolinska Institutet

Swedish Research Council

Swedish Research Council for Health, Working Life and Welfare

Swedish National Graduate School

Aging and Health

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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