Association of the Discordance Between Apolipoprotein B and Low-Density Lipoprotein Cholesterol With Cognition.

BACKGROUND

This study aimed to investigate and validate the association of the discordance between apoB (apolipoprotein B) and low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol with cognitive function and explore the mediating role of cerebral large- and small-vessel diseases on this association, for which previous evidence was limited.

METHODS

Community-dwelling adults aged >50 years from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events study were included in this cross-sectional study. Global cognitive function was evaluated using the Montreal Cognitive Assessment. The association of the residuals between apoB and LDL-C or non-high-density lipoprotein cholesterol levels with Montreal Cognitive Assessment score was explored using multivariate linear regression. The simple mediating effects of neuroimaging markers of cerebral large atherosclerotic disease and cerebral small-vessel disease on this association were analyzed.

RESULTS

This study included 2916 participants (age: 61.01±6.63 years, female sex: 1553 [53.26%]). Total Montreal Cognitive Assessment scores and visuospatial/executive function, naming, attention, language, abstraction, delayed memory, and orientation subscores differed significantly among 3 groups stratified by the residuals between apoB and LDL-C. Increased residuals between apoB and LDL-C were associated with decreased Montreal Cognitive Assessment score postadjustment. Intracranial atherosclerotic plaque presence and burden mediated 13.36% and 10.87% of this association, respectively; the mediation effect of intracranial atherosclerotic plaque presence postadjustment was 5.67%. The validation study confirmed these findings, with 10.04% and 9.08% postadjustment mediation effects of the presence and burden of intracranial atherosclerotic plaque, respectively, on the association.

CONCLUSIONS

High discordance between apoB and LDL-C was associated with poor cognitive function, partially mediated by intracranial atherosclerotic plaque.