Age at Onset of Heart Failure and Subsequent Risk of Dementia A Longitudinal Cohort Study

BACKGROUND The average age at onset of heart failure (HF) shows a progressive decrease in recent years; however, the association between age at onset of HF and risk of subsequent dementia remains undetermined. OBJECTIVES This study sought to examine whether younger onset age of HF is associated with a higher risk of incident dementia. METHODS Individual -level data from the UK Biobank cohort study were analyzed in the present study. Cox regression models and the propensity score matching method were used to analyze the associations of HF and its onset age with subsequent all -cause dementia, Alzheimer disease (AD), and vascular dementia (VD). RESULTS Compared with 442,791 participants without HF, those with HF had a higher risk of all -cause dementia (HR: 1.14). Among 14,413 participants with HF, multivariable-adjusted HRs for all -cause dementia, AD, and VD were 1.18, 1.64, and 1.27, respectively, per 10 -year decrease in age at HF onset. The propensity score matching analyses found that the strength of association between HF and all -cause dementia increased with decreasing onset age of HF ( $75 years, HR: 1.05; 65-74 years, HR: 1.10; <65 years, HR: 1.67) after multivariable adjustment. Similarly, participants with onset age of HF <65 years had the greatest HRs for incident AD and VD, compared with their matched control subjects. CONCLUSIONS Younger age at HF onset was associated with increased risk of dementia. Individuals with an onset age of HF before 65 years of age may represent a particularly vulnerable population for dementia irrespective of subtypes and need careful monitoring and timely intervention to attenuate subsequent risk of incident dementia.