Sex differences in cognitive functioning in patients with heart failure
Cognitive impairment is common in patients with heart failure (HF) and impacts patients' life. Sex differences in HF-characteristics are well-established. We hypothesized that women and men with HF also differ in cognitive functioning and that this may be related to sex differences in HF-charac...
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Veröffentlicht in: | International journal of cardiology 2025-01, Vol.418, p.132603, Article 132603 |
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Zusammenfassung: | Cognitive impairment is common in patients with heart failure (HF) and impacts patients' life. Sex differences in HF-characteristics are well-established. We hypothesized that women and men with HF also differ in cognitive functioning and that this may be related to sex differences in HF-characteristics and vascular brain injury.
In the Heart-Brain Connection Study, 162 clinically stable HF patients (mean age 69.7 ± 10.0, 33 % women) underwent neuropsychological assessments and brain-MRI. Test results were standardized into z-scores for memory, language, attention/speed, executive functioning, and global cognition. Using linear models adjusted for age and education, we calculated sex differences (women-to-men: W-M∆) in cognitive functioning and examined effects of HF- and vascular brain injury-characteristics on these differences.
Men more often had an ischemic cause of HF and lower NYHA-classes, whereas women more often had preserved left ventricular ejection fractions (LVEF). Women had a higher volume of white matter hyperintensities (WMHs) whereas non-lacunar infarcts and microbleeds were more prevalent in men. Women performed better on global cognition than men (W-M∆ in z-score 0.20, 95 %CI 0.03–0.37), predominantly on memory (0.40, 0.02–0.78). These differences were associated with ischemic HF-etiology, as adjustment attenuated these sex differences. After adjustment for non-lacunar infarcts, global cognition difference persisted, but the difference in memory functioning attenuated. Adjustments for NYHA-class, LVEF, WMHs, and microbleeds did not change the results.
Women and men with HF differ in cognitive functioning, predominantly in memory functioning, these differences were related to some sex differences in HF-characteristics and vascular brain injury, but not to all.
•Women and men with heart failure differ in cognitive functioning, predominantly on the memory domain.•These differences were related to an ischemic heart failure etiology.•These differences may result in underestimation of cognitive impairment in women, when only the memory domain is tested. |
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ISSN: | 0167-5273 1874-1754 1874-1754 |
DOI: | 10.1016/j.ijcard.2024.132603 |