OBJECTIVE

To assess the prevalence of cognitive impairment (CI) among outpatient individuals aged ≥55 years with arterial hypertension (AH) and/or coronary artery disease (CAD), and to evaluate the association between CI and all-cause mortality over a five-year follow-up period.

MATERIAL AND METHODS

This study was conducted within the framework of the COMETA trial. We enrolled 2.775 patients aged ≥55 years with AH and CAD, as well as no prior diagnosis of dementia or cognitive impairment. Patients attended general practitioners or cardiologists in territorial outpatient clinics in 30 cities across 7 federal districts of the Russian Federation. Clinical characteristics, all traditional cardiovascular risk factors, and psychosocial risk factors were analyzed. Screening for CI was performed using the Clock Drawing Test (CDT) and two screening questions: “Have you noticed a decline in attention?” and “Have you noticed a decline in memory?” Prospective follow-up phase included telephone interviews with patients (or their close relatives) conducted by trained specialists at 1.5, 3, and 5 years after inclusion. W documented vital status (myocardial infarction, stroke, other major illnesses, hospitalizations, and death).

RESULTS

CI according to CDT (≤3 points) was identified in 29.8% of patients with AH/CAD. Each additional year of age was associated with 2—3% increase in odds of CI. Low physical activity, elevated systolic blood pressure, and hypercholesterolemia were associated with 27—43% increase in odds of CI, whereas regular or occasional consumption of low doses of alcohol was associated with 25% reduction in odds of CI (without sufficient evidence to consider it a protective factor). CI was not associated with stress, anxiety, or type D personality. However, it was significantly associated with clinically relevant depressive symptoms, previous mental disorders and self-reported decline in attention and memory (increasing the odds of CI by 22—59%). CI was associated with lower five-year survival (88.2% vs 92.3%) and increased the risk of death by 56%. There was a dose—response relationship between CDT score and mortality: each 1-point increase in CDT score was associated with 11% reduction in five-year mortality risk. These associations were significant after adjustment for age, sex, traditional risk factors, CAD, and diabetes mellitus. Clear subjective complaints of impaired attention and memory were associated with 1.7—2.2-fold increase in five-year mortality risk with prognostic value comparable to that of CDT.

CONCLUSION

Cognitive impairment identified by CDT is highly prevalent among patients with AH/CAD and associated with increased all-cause mortality. These findings demonstrate high prognostic value of CDT and subjective patient-reported cognitive complaints supporting the need to incorporate proactive CI screening into routine clinical practice for patients with AH/CAD to improve risk stratification and guide secondary prevention strategies.