Impact of cognitive ability in early adult life on image-based primary prevention of cardiovascular disease on among men aged 40-60 years
Authors: Norberg M , Holmberg H , Nordin S , Wester P , Naslund U , Liv P 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Swedish Research Council Region Västerbotten.

Introduction
Low early life cognitive ability is associated with high risk of CVD morbidity and mortality, and non-adherence to secondary prevention. A beneficial effect of an intervention with pictorial presentation of subclinical atherosclerosis based on ultrasonography, given to healthy participants and their physicians, resulting in lower risk of CVD after three years of follow-up, compared to only CVD risk factor assessment, was previously shown, as well as considerably higher increase of dispensing of statins. These effects were irrespective of participants’ educational level.

Purpose
To assess the impact of early life cognitive ability on this intervention during adult life, aiming at primary prevention av CVD, on SCORE 2 and self-reported statin medication during three years.

Methods
Study population: Male participants in a pragmatic RCT N=1545 (SCORE2, control 797 and intervention 748), after exclusion of men with statins at baseline N=1275 (665 and 610, respectively).
Variable of interest: Cognitive ability at age 18-19 years, from the psychological testing of the Swedish Conscripts, as a modifier of the intervention. The mean of four subtests ranging from 1-9 was used.
Outcome variables: SCORE2 and self-reported use of statin treatment, initiated after base-line, after three years
Statistical methods: ANCOVA with SCORE2 at 3-year follow-up as dependent variable, and intervention arm, including an interaction between intervention arm and early cognitive ability, as independent variables, as well as adjustment for baseline SCORE2. Logistic regression with self-reported initiation of statin treatment as dependent variable, and intervention arm, including an interaction between intervention with early cognitive ability as independent variables.

Results
At baseline, there were no differences between the groups in SCORE2 and self-reported use of statins. At 3-year follow-up, mean SCORE2 for the control group and the intervention group was 7.9 and 7.7, respectively. The proportion of participants on statin treatment at 3year FU was 9.8% and 21.1%, respectively.
The average treatment effect during the three years (no interaction with early cognitive ability assumed) on SCORE2 was B= -0.31 (95% CI: [-0.56, -0.05], p = 0.019) and for statin initiation OR= 2.45 (95 CI: [1.75, 3.47], p &lt;0.001). However, no significant interactions between intervention effect and early cognitive ability was found for SCORE2 (p= 0.60) nor for initiation of statins (p= 0.17).

Conclusions
No heterogeneity in intervention effect due to early cognitive ability was seen. Thus, visual presentation of subclinical atherosclerosis given to healthy participants’ and their physicians demonstrated similar effect on the 10-year risk of CVD and on self-reported use of statins irrespective of early life cognitive ability. More prescriptions of statins, higher adherence to recommended statin treatment and lifestyle modifications may contribute to the intervention effects.