Carotid- intima media thickness is independently associated with cognitive decline. The INVADE study.

OBJECTIVES: Increased carotid intima-media thickness (C-IMT) is a non-invasive marker of atherosclerosis and predicts vascular events. Moreover, increasing evidence suggests an association between carotid atherosclerosis and cognitive decline. The purpose of this study is to investigate the relationship between C-IMT and the development of cognitive impairment in a large population-based sample. METHODS: This study was based on the data of the participants of the INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg, Bavaria) project. Vascular risk factors, Geriatric depression scale (GDS) and "6 Item Cognitive Impairment Test" (6CIT) were evaluated at baseline and after 2 years. The relationship between C-IMT and cognitive impairment was analysed using multivariate logistic regression. RESULTS: Complete baseline data were available in 3386 subjects (mean age 67.7 [95% confidence interval (CI): 67.5, 68.0] years, 41% male). During follow-up, 174 subjects developed a new cognitive impairment. In the subgroup without cognitive impairment at baseline a significant association between cognitive decline after 2 years and elevated C-IMT at baseline could be detected with a significantly higher baseline C-IMT in those with cognitive decline (0.87 mm vs. 0.78 mm; p < 0.0001). After adjustment for various risk factors only age, GDS baseline 6CIT and C-IMT were independently associated with the development of a new cognitive impairment. CONCLUSIONS: Our data indicate that an increased carotid intima-media thickness predicts a cognitive decline in an elderly population without prevalent cognitive impairment.

[Modification of vascular risk factors by intervention on the primary care level. Results of the INVADE project]. / Modifikation vaskulärer Risikofaktoren durch hausärztliche Intervention. Ergebnisse des Projekts INVADE.

BACKGROUND: The so-called INVADE project examines the efficacy of consistent diagnosis and treatment of cerebrovascular risk factors on the incidence of stroke. METHODS: This analysis compares known cardiovascular risk factors (elevated blood pressure, dipositas, hyperlipidemia, diabetes mellitus, and smoking) and respective medication of 2930 patients with respect to cerebrovascular disease, peripheral arterial disease (PAD), and coronary heart disease (CHD) between baseline and follow-up examination after 2 years of intervention. RESULTS: Using the ankle-brachial index (ABI), 381 patients (13%) with asymptomatic PAD were identified. Comparison between baseline and follow-up examination revealed significant reductions in the following risk factors. Cerebrovascular disease: elevated blood pressure -12.8%, dipositas -4.2%, and LDL -8.1%. For PAD the results were: elevated blood pressure -7.2%, smoking -1.2%, elevated cholesterol -6.4%, dipositas -3.2%, and LDL -7.4%. For CHD the results were: elevated blood pressure -11.3%, elevated cholesterol -13.0%, and LDL -14.9%. CONCLUSION: By the use of ABI, previously undiagnosed asymptomatic PAD was identified in 13% of all patients. Two-year intervention on the primary care level yielded significant reduction of known vascular risk factors.

[Significant reduction of vascular risk factors within the framework of the population-based intervention project INVADE--a 2-year follow-up study]. / Signifikante Reduktion vaskulärer Risikofaktoren im Rahmen des populationsbasierten Interventionsprojektes INVADE--Eine 2-Jahres-Verlaufsuntersuchung.

BACKGROUND: The INVADE project (Intervention project of cerebrovascular diseases and dementia in the district of Ebersberg) analyzes the effect of risk factor evaluation and modification on the incidence of stroke and dementia. Here we evaluated the changes of risk factors after two years in the INVADE population, particularly in participants with diabetes mellitus and coronary heart disease (CHD). PATIENTS AND METHODS: Baseline data of 3909 participants were available. In addition to common risk factors and new risk indicators, various social demographic data and life style parameters were analyzed. A guideline-based therapy was proposed for each participant based on an individual risk profile. The differences between baseline and the 2-year follow-up data were analyzed using the paired t-test and the McNemar test. RESULTS: Complete follow-up data were available in 3185 participants (1288 men; mean age 69.5 years). For the overall project population the reduction of traditional risk factors was effective, particularly in subjects with hypertension or diabetes. The prevalence of hypertension was 76 %, including 19 % newly diagnosed subjects. In this subgroup, the systolic blood pressure could be reduced by 4.7 mmHg. 20.3 % of the participants showed a diabetes mellitus, blood glucose level decreased about 8 %. Additionally an improvement in hypertension therapy and lipid levels was seen. Comparable results were achieved in the CHD subgroup. Additionally, in the overall study population treatment with antihypertensives and statins increased significantly. DISCUSSION: Even after two years, the INVADE project was able to reduce vascular risk factors particularly in high risk patients with diabetes and CHD. Based on these findings, the primary aim of the project, the reduction of stroke and dementia incidence, can be achieved.