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. 2025 Apr 22;32(6):477-484.
doi: 10.1093/eurjpc/zwae153.

Diabetes and coronary artery disease as risk factors for dementia

Kevin K W Olesen  1   2 , Pernille G Thrane  1 , Christine Gyldenkerne  1   3 , Reimar W Thomsen  3   4 , Janne K Mortensen  4   5 , Steen D Kristensen  1   4 , Michael Maeng  1   4
Affiliations

Diabetes and coronary artery disease as risk factors for dementia

Kevin K W Olesen et al. Eur J Prev Cardiol. .

Abstract

Aims: Diabetes is associated with an increased risk of dementia, but it is still debated to which degree this risk depends on the presence of atherosclerotic cardiovascular disease (CVD). In this study, we hypothesize that patients with diabetes and coexisting coronary artery disease (CAD), as a marker of systemic atherosclerotic CVD, have a substantially higher risk of developing dementia.

Methods and results: Patients ≥65 years, who underwent coronary angiography, were stratified by diabetes and CAD. Outcomes were all-cause dementia, Alzheimer's dementia, and vascular dementia. We estimated adjusted hazard ratios (aHRs) using patients with neither diabetes nor CAD as a reference. A total of 103 859 patients were included. Of these, 23 189 (22%) had neither diabetes nor CAD, 3876 (4%) had diabetes, 61 020 (59%) had CAD, and 15 774 (15%) had diabetes and CAD. During a median follow-up of 6.3 years, 5592 (5.5%) patients were diagnosed with all-cause dementia. Patients with diabetes and CAD had the highest HR of all-cause dementia [aHR 1.37, 95% confidence interval (CI) 1.24-1.51], including Alzheimer's dementia (aHR 1.41, 95% CI 1.23-1.62) and vascular dementia (aHR 2.03, 95% CI 1.69-2.45). Patients with diabetes alone (aHR 1.14, 95% CI 0.97-1.33) or CAD alone (aHR 1.11, 95% CI 1.03-1.20) had a modestly increased rate of all-cause dementia.

Conclusion: The combination of diabetes and CAD is associated with an increased rate of dementia, in particular vascular dementia, suggesting that the diabetes-related risk of dementia is partly mediated through concomitant atherosclerotic CVD. This underscores the importance of atherosclerotic CVD prevention in diabetic patients to reduce cognitive decline.

Keywords: Coronary artery disease; Dementia; Diabetes; Stroke.

Plain language summary

We used national Danish healthcare registries to follow 103 859 patients examined by coronary angiography for up to 10 years to estimate the risk of dementia associated with diabetes and/or coronary artery disease (CAD). We found that diabetes and CAD, separately, were only modest risk factors for dementia. However, diabetes and CAD in combination were associated with the highest risk of dementia, in particular vascular dementia. Our results suggest that the risk of dementia associated with diabetes is partly mediated through the presence of atherosclerotic cardiovascular disease (CVD), which underscores the importance of atherosclerotic CVD prevention in diabetic patients to reduce the risk of cognitive decline.

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Conflict of interest statement

Conflict of interest: K.K.W.O. is supported by a grant from the Danish Cardiovascular Academy (grant no. CPD5Y-2022001-HF), which is funded by the Danish Heart Association and the Novo Nordisk Foundation. P.G.T., J.K.M., and C.G. have no conflicts to report. R.W.T. has no personal conflicts to report; the Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to (and administered by) Aarhus University; none of these studies are related to the present study. S.D.K. is the national coordinator of the SOS-AMI trial and has received departmental grants from Idorsia. M.M. is supported by a grant from the Novo Nordisk Foundation (grant no. NNF22OC0074083); has received lecture and advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Novo Nordisk, Denmark; and has received institutional research grants from Bayer, Novo Nordisk, and Volcano (now Philips).

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