Association of coronary artery bypass with cognitive impairment in coronary artery disease across APO (ε) genotypes in AllofUS
Praveen Hariharan, Minoo Bagheri, Emelia Asamoah, Ioana Voiculescu, Purnima Singh, Tafadzwa Machipisa, Tess Pottinger, Antone OpekunBackground
Coronary artery bypass graft (CABG) is a widely performed procedure for coronary artery disease (CAD), yet its association with impaired cognition (IC), that is, mild-cognitive impairment or all-cause dementia, while accounting for apolipoprotein E (APO (ε)) genotype, remains unclear.
Methods
We analysed AllofUS participants with CAD (age ≥60 years) from 2017 to 2023. We defined CAD as a history of angina/myocardial infarction/chronic ischaemic heart disease or having percutaneous coronary intervention/CABG, and IC as mild cognitive impairment or all-cause dementia using International Classification of Diseases (ICD)/systematized nomenclature of medicine (SNOMED) codes. We performed logistic regression analyses to assess the association between CABG and IC, adjusting for clinical factors (age, sex, hypertension, diabetes, hyperlipidaemia, depression, stroke, smoking, alcohol use, statin/antihypertensive/antidiabetic use), social determinants (self-reported race/ethnicity, income, employment) and APO (ε) genotypes. We further performed stratified analyses across APO (ε) genotypes (ε2/ε2, ε2/ε3, ε3/ε3, ε2/ε4, ε3/ε4, ε4/ε4). We defined significance at p≤0.05.
Results
We included 22 349 with CAD and identified 908 with IC after CAD until 2023. 40% were females, 70% were White, 12% were Black and 9% were Hispanic. The proportion of IC was higher (5.1% vs 3.5%, p=1e-08) in CABG (n=8135) vs non-CABG (n=14 214). After adjusting for clinical factors, social determinants and APO (ε) genotypes, CABG (1.23; 1.06–1.41, p=0.005) was associated with IC. In APO (ε) stratified analysis, the association of CABG with IC was strongest in the APO ε2/ε3 group (1.91; 1.21–3.02, p=0.005).
Conclusion
In the AllofUS cohort, we observed an association between CABG and IC in CAD participants, with the strongest association in the APO ε2/ε3 group.