Published Online
on January 15, 2007

A more recent version of this article appeared on March 1, 2007

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Submitted on September 8, 2006
Revised on September 23, 2006

Left Ventricular Mass, Blood Pressure, and Lowered Cognitive Performance in the Framingham Offspring

Merrill F. Elias; Lisa M. Sullivan; Penelope K. Elias^*; Ralph B. D’Agostino Sr; Philip A. Wolf; Sudha Seshadri; Rhoda Au; Emelia J. Benjamin; and Ramachandran S. Vasan

From the Statistics and Consulting Unit (M.F.E., R.B.D.), Department of Mathematics and Statistics, Boston University, Mass; the Department of Biostatistics (L.M.S), Boston University School of Public Health, Mass; the Department of Psychology (M.F.E., P.K.E.), University of Maine, Orono; and the Departments of Neurology (P.A.W., S.S., R.A.), Preventive Medicine (E.J.B., R.S.V.), and Cardiology (E.J.B., R.S.V.), Boston, Mass.

^* To whom correspondence should be addressed. E-mail: mfelias{at}aol.com.

Abstract--The purpose of this study was to determine whether echocardiographic left ventricular mass is related to cognitive performance beyond casual blood pressure adjusting for the influence of other vascular risk factors. We used multivariable regression analyses to relate left ventricular mass assessed at a routine examination (1995-1998) to measures of cognitive ability obtained routinely (1998-2001) in 1673 Framingham Offspring Study participants (56% women; mean age: 57 years) free from stroke, transient ischemic attack, and dementia. We adjusted for the following covariates hierarchically: (1) age, education, sex, body weight, height, interval between left ventricular mass measurement and neuropsychological testing (basic model); (2) basic model+blood pressure+treatment for hypertension; and (3) basic model+blood pressure+treatment for hypertension+vascular risk factors and prevalent cardiovascular disease. For the basic model, left ventricular mass was inversely associated with abstract reasoning (similarities), visual-spatial memory and organization, and verbal memory. For the basic model+blood pressure+treatment for hypertension, left ventricular mass was inversely associated with similarities and visual-spatial memory and organization. For the basic+blood pressure+treatment for hypertension+risk factors+cardiovascular disease model, no significant associations were observed. Echocardiographic left ventricular mass is associated with cognitive performance beyond casual and time-averaged systolic blood pressure, but this association is attenuated and rendered nonsignificant with additional adjustment for cardiovascular risk factors and cardiovascular disease, thus suggesting that these variables play an important role in mediating the association between left ventricular mass and cognition.

Key words: left ventricular mass • blood pressure • cognitive performance • cardiovascular risk factors • cardiovascular disease

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