Sex differences in the association between cardiovascular diseases and dementia subtypes: A prospective analysis of 464,616 UK Biobank participants

Caiyun Dong, Shandong University, China
Chunmiao Zhou, Shandong University, China
Chunying Fu, Shandong University, China
Wenting Hao, Shandong University, China
Akihiko Ozaki, Jyoban Hospital of Tokiwa Foundation, Japan
Nipun Shrestha, University of Liverpool, United Kingdom
Salim S. Virani, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, United States of America
Shiva Raj Mishra, Academy for Data Sciences and Global Health, Nepal
Dongshan Zhu, Shandong University, China

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Background: Whether the association of cardiovascular diseases (CVDs) with dementia differs by sex remains unclear, and the role of socioeconomic, lifestyle, genetic, and medical factors in their association is unknown.
Methods: We used data from the UK Biobank, a population-based cohort study of 502,649 individuals. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between CVD (coronary heart diseases (CHD), stroke, and heart failure) and incident dementia (all-cause dementia, Alzheimer's Disease (AD), and vascular dementia (VD)). The moderator roles of socioeconomic (education, income), lifestyle (smoking, BMI, leisure activities, and physical activity), genetic factors (APOE allele status), and medical history were also analyzed.
Results: Compared to people who did not experience a CVD event, the HRs (95%CI) between CVD and all-cause dementia were higher in women compared to men, with an RHR (Female/Male) of 1.20 (1.13, 1.28). Specifically, the HRs for AD were higher in women with CHD and heart failure compared to men, with an RHR (95%CI) of 1.63 (1.39, 1.91) and 1.32 (1.07, 1.62) respectively. The HRs for VD were higher in men with heart failure than women, with RHR (95%CI) of 0.73 (0.57, 0.93). An interaction effect was observed between socioeconomic, lifestyle, genetic factors, and medical history in the sex-specific association between CVD and dementia.
Conclusion: Women with CVD were 1.5 times more likely to experience AD than men, while had 15% lower risk of having VD than men.