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Association Between Alcohol Use Disorders and Dementia in 262,703 Dementia-free Finnish Adults: Is Cardiovascular Disease a Mediator?

Is Cardiovascular Disease a Mediator?
Authors: Yaoyue Hu; Kaarina Korhonen; Peng Li; Martin Bobak; Pekka Martikainen; Maarten J Bijlsma;

Association Between Alcohol Use Disorders and Dementia in 262,703 Dementia-free Finnish Adults: Is Cardiovascular Disease a Mediator?

Abstract

Abstract Background The possible mediating role of cardiovascular disease (CVD) in the relationship between alcohol use disorders (AUD) and the risk of early-onset (<age 65) and late-onset (≥age 65) dementia lacks formal investigation. Methods Using linked Finnish national register data, a population-based cohort study of 262,703 dementia-free Finnish men and women aged 40 + at baseline (December 31, 1999) was established. AUD and CVD in 1988–2014, and incident dementia in 2000–2014 were identified from Finnish Hospital Discharge Register and/or Drug Reimbursement Register. Causal association and mediation were assessed using mediational g-formula. Results AUD was associated with a substantial increase in the risk of early-onset dementia in both men (hazard ratio: 5.67, 95% confidence interval: 4.37–7.46) and women (6.13, 4.20–8.94) after adjustments for confounding; but the elevated risk for late-onset dementia was smaller (men: 2.01, 1.80–2.25; women: 2.03, 1.71–2.40). Mediational g-formula results showed that these associations were causal in men with no mediation by CVD as the virtually identical total effect of AUD (early-onset: 5.26, 3.48–7.48; late-onset: 2.01, 1.41–2.87) and direct effect of AUD (early-onset: 5.24, 3.38–7.64; late-onset: 2.19, 1.61–2.96) were found with no indirect effect via CVD. In women, the results were similar for late-onset dementia (total effect: 2.80, 1.70–4.31; direct effect: 2.92, 1.86–4.62) but underpowered for early-onset dementia. Conclusion AUD increased dementia risk, particularly the risk of early-onset dementia. This elevated risk of dementia associated with AUD was not mediated by CVD. Clinicians should consider the increased risk of dementia in the management of middle-aged and older adults with a history and/or current AUD.

Keywords

Male, Cardiovascular Diseases/epidemiology, Finland/epidemiology, g-formula, Middle Aged, Public health care science, environmental and occupational health, alchol use disorders, Cohort Studies, Alcoholism, Alcohol use disorders, cardiovascular disease, Cardiovascular Diseases, Risk Factors, Alcoholism/complications, Humans, Female, Finland, causal mediation, dementia, Aged

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
hybrid