Abstract Body: Introduction: We examined whether prestroke cardiovascular risk is associated with faster cognitive decline and higher dementia risk after stroke independent of prestroke cognition.

Methods: We included 1,808 dementia-free individuals with incident stroke (91% ischemic, 7% hemorrhagic, 2% other; 52% women, 38% Black, median age 75) from 4 cohorts (1971-2019): Atherosclerosis Risk In Communities Study, Cardiovascular Health Study, Framingham Offspring Study, and REasons for Geographic And Racial Differences in Stroke. We assessed prestroke atherosclerotic cardiovascular disease (ASCVD) risk with the American Heart Association’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) 10-year ASCVD risk score, which has age and sex as risk factors. Outcomes were global cognition (primary), executive function, memory, and dementia. Linear mixed-effects and Cox regression models examined continuous and categorical (quintiles) 10-year ASCVD risk scores and adjusted for mean prestroke cognition, race, education, and cohort. Median (IQR) follow-up was 4.4 (2.0, 7.9) years for global cognition and 5.1 (2.4, 8.8) for dementia. Dementia cases totaled 142 at 5 years and 182 at 10 years.

Results: Median (IQR) 10-year prestroke ASCVD risk was 14.0% (9.9%, 18.5%). Higher prestroke 10-year ASCVD risk was associated with lower adjusted initial poststroke global cognition, memory, and executive function (changes to intercept, Table 1). The quintile analysis showed a dose-response relationship between higher prestroke ASCVD risk and lower initial poststroke cognition scores (changes to intercept, Table 1). The overall stroke survivor group had unadjusted mean declines of -0.59 points/year (95%CI, -0.66 to -0.52 points/year; P<0.001) for global cognition, -0.54 points/year (95%CI, -0.62 to -0.46 points/year; P<0.001) for executive function, and -0.35 points/year (95%CI, -0.42 to -0.28 points/year; P<0.001) for memory. Higher prestroke 10-year ASCVD risk was associated with faster global cognitive decline (P<0.001) and nominally faster memory decline (P=0.10) but not executive function decline (P=0.80) (changes to poststroke slope, Table 1). Higher quintiles of prestroke ASCVD risk were associated with faster global cognitive decline and higher 5- and 10-year dementia risk (Tables 1-2; Figure 1).

Conclusions: Higher prestroke cardiovascular risk is associated with lower initial poststroke cognitive scores, faster cognitive decline, and higher dementia risk in stroke survivors.