A cross-sectional analysis of racial differences in accelerated aging and cognitive function among patients with atrial fibrillation: The SAGE-AF study: Forrester, Accelerated aging and cognitive function

Sarah N Forrester; David D McManus; Jane S Saczynski; Isabelle C Pierre-Louis; Benita A Bamgbade; Catarina I Kiefe

doi:10.1016/j.eclinm.2021.101060

A cross-sectional analysis of racial differences in accelerated aging and cognitive function among patients with atrial fibrillation: The SAGE-AF study: Forrester, Accelerated aging and cognitive function

EClinicalMedicine. 2021 Jul 31:39:101060. doi: 10.1016/j.eclinm.2021.101060. eCollection 2021 Sep.

Authors

Sarah N Forrester¹, David D McManus², Jane S Saczynski³, Isabelle C Pierre-Louis³, Benita A Bamgbade³, Catarina I Kiefe³

Affiliations

¹ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street AS6-1075, Worcester, MA 01605, United States.
² Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
³ Department of Pharmacy and Health System Sciences, Northeastern University, Boston MA, United States.

Abstract

Background: Non-Whites are more likely to suffer from cognitive impairment and complications of atrial fibrillation (AF) than Whites, though Whites are more likely to be diagnosed with AF. We examined whether non-Whites with AF are biologically older than Whites with AF and whether accelerated biological aging is associated with cognitive functioning.

Methods: We used baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation prospective cohort study, collected 2016-2020 across ambulatory care practices in Massachusetts and Georgia. Of 1244 enrolled, 974 participants with full biological data were included in the present analysis. Accelerated aging (AccA) was calculated based on a combination of biomarkers associated with age and physiological "wear and tear."

Findings: The main outcome was score on Montreal Cognitive Assessment (MoCA). Non-Whites had 2.9 years more AccA than Whites and higher AccA was associated with a lower MoCA score among both Whites (-0.06, 95% CI: -0.10, -0.03) and non-Whites (-0.14, 95% CI: -0.27, 0.02). This association was significantly greater among non-whites (-0.11, 95% CI: -0.20, -0.01).

Interpretation: Non-White AF patients are functionally "older" than their White counterparts and experience a stronger deleterious association between AccA and cognition. These findings underscore the importance of taking functional age into account when treating patients with AF, particularly non-White patients, to enhance treatment and improve AF outcomes.