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Prognostic significance of moderate cognitive impairment in patients at high and very high cardiovascular risk

Objective: to assess the prognostic significance of cognitive impairment (CI) detected using the Mini-Mental State Examination (MMSE) scale in patients at high and very high cardiovascular risk (CVR). Patients and methods. The investigation enrolled 111 men and women aged 40-75 years at high and very high CVR. High and very high CVR was established in 30 (27.0%) and 81 (73.0%), respectively. The median MMSE score in the examinees was 28.0 (27.0–28.0). The MMSE score was equal to ≥28 in 71 (63.9%) patients. Moderate CI (MCI) was found in 40 (36.1%) patients. The follow-up duration was 24.6 (14.4–34.5) months. The combined endpoint was taken to be death from cardiovascular causes, nonfatal myocardial infarction or unstable angina requiring hospitalization, nonfatal stroke, and coronary revascularization. Results and discussion. The events constituting the combined endpoint occurred in 40 (36.0%) patients. The Kaplan-Meier analysis showed that patients with MCI (24–27 MMSE scores) had a significantly lower >2-year survival rate. The Cox regression analysis established that MCI was associated with a 2.56-fold increase in the relative risk (RR) of the adverse cardiovascular events constituting the endpoint (95% CI, 1.22–5.33; p=0.013). The prognostic value of CI, in particular with respect to the development of cardiovascular events, was observed in various age groups of patients. MMSE is a simple screening test that should be used more widely, including for the identification of patients at increased CVR. Conclusion. The presence of MCI is associated with the RR of adverse cardiovascular events.