Association of left ventricular hypertrophy with cognitive decline and dementia risk over 20 years: The Atherosclerosis Risk In Communities-Neurocognitive Study (ARIC-NCS).

BACKGROUND: Left ventricular hypertrophy (LVH) is an indicator of organ damage largely due to hypertension. We assessed whether LVH was associated with dementia and cognitive function in the Atherosclerosis Risk in Communities study.

METHODS: Our analysis included 12,665 individuals (23% black race, 56% female, mean age 57) who attended visit 2 in 1990-1992. Cornell voltage (SV3 + RaVL) was derived from 12-lead electrocardiograms and dichotomized as LVH using sex-specific criteria (>28 mm men; >22 mm women). Incident dementia was defined by expert review using a predetermined algorithm, and cognitive function was measured longitudinally using 3 tests. A Cox model was used to evaluate the association between time-dependent LVH and dementia adjusted for time-varying covariates from 1990 to 2013. Linear regression models fit with generalized estimating equations were used to evaluate LVH with cognitive function.

RESULTS: During a mean follow-up of 18 years, we identified 544 participants with LVH and 1,195 dementia cases. LVH was associated with a higher risk of dementia: multivariable hazard ratio = 1.90; 95% CI: 1.47-2.44. Those with LVH had lower cognitive scores at baseline; however, there was no difference in the rate of cognitive decline over 20 years in those with LVH versus those without LVH.

CONCLUSIONS: In this population-based study, LVH measured during midlife was associated with an increased risk of incident dementia; however, LVH was not associated with additional cognitive decline. These results underscore the need for hypertension control to prevent subclinical brain injury.