Stroke Is Predicted by Low Visuospatial in Relation to Other Intellectual Abilities and Coronary Heart Disease by Low General Intelligence

PLOS ONE, Dec 2019

Background Low intellectual ability is associated with an increased risk of coronary heart disease and stroke. Most studies have used a general intelligence score. We studied whether three different subscores of intellectual ability predict these disorders. Methods We studied 2,786 men, born between 1934 and 1944 in Helsinki, Finland, who as conscripts at age 20 underwent an intellectual ability test comprising verbal, visuospatial (analogous to Raven's progressive matrices) and arithmetic reasoning subtests. We ascertained the later occurrence of coronary heart disease and stroke from validated national hospital discharge and death registers. Results 281 men (10.1%) had experienced a coronary heart disease event and 131 (4.7%) a stroke event. Coronary heart disease was predicted by low scores in all subtests, hazard ratios for each standard deviation (SD) lower score ranging from 1.21 to 1.30 (confidence intervals 1.08 to 1.46). Stroke was predicted by a low visuospatial reasoning score, the corresponding hazard ratio being 1.23 (95% confidence interval 1.04 to 1.46), adjusted for year and age at testing. Adjusted in addition for the two other scores, the hazard ratio was 1.40 (1.10 to 1.79). This hazard ratio was little affected by adjustment for socioeconomic status in childhood and adult life, whereas the same adjustments attenuated the associations between intellectual ability and coronary heart disease. The associations with stroke were also unchanged when adjusted for systolic blood pressure at 20 years and reimbursement for adult antihypertensive medication. Conclusions Stroke is predicted by low visuospatial reasoning scores in relation to scores in the two other subtests. This association may be mediated by common underlying causes such as impaired brain development, rather than by mechanisms associated with risk factors shared by stroke and coronary heart disease, such as socio-economic status, hypertension and atherosclerosis.

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Stroke Is Predicted by Low Visuospatial in Relation to Other Intellectual Abilities and Coronary Heart Disease by Low General Intelligence

et al. (2012) Stroke Is Predicted by Low Visuospatial in Relation to Other Intellectual Abilities and Coronary Heart Disease by Low General Intelligence. PLoS ONE 7(11): e46841. doi:10.1371/journal.pone.0046841 Stroke Is Predicted by Low Visuospatial in Relation to Other Intellectual Abilities and Coronary Heart Disease by Low General Intelligence Eero Kajantie 0 Katri Ra ikko nen 0 Markus Henriksson 0 Jukka T. Leskinen 0 Tom Forse n 0 Kati Heinonen 0 Anu-Katriina Pesonen 0 Clive Osmond 0 David J. P. Barker 0 Joh 0 n G. Eriksson 0 Manos Tsakiris, Royal Holloway, University of London, United Kingdom 0 1 National Institute for Health and Welfare , Helsinki , Finland , 2 Children's Hospital, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland , 3 University of Helsinki, Department of Behavioural Sciences , Helsinki , Finland , 4 National Supervisory Authority for Welfare and Health , Helsinki , Finland , 5 Centre of Military Medicine , Finnish Defence Forces, Lahti , Finland , 6 National Defence College , Finnish Defence Forces, Tuusula , Finland , 7 Vasa Central Hospital , Vasa , Finland , 8 Department of General Practice and Primary Health Care, University of Helsinki , Helsinki , Finland , 9 Vasa Health Care Centre , Vasa , Finland , 10 MRC Epidemiology Resource Centre, University of Southampton, Southampton, United Kingsom, 11 Heart Research Center, Oregon Health and Science University , Portland, Oregon , United States of America, 12 Chair of Fetal Programming, King Saud University , Riad , Saudi Arabia , 13 Unit of General Practice, Helsinki University Central Hospital , Helsinki , Finland , 14 Folkha lsan Research Centre , Helsinki , Finland Background: Low intellectual ability is associated with an increased risk of coronary heart disease and stroke. Most studies have used a general intelligence score. We studied whether three different subscores of intellectual ability predict these disorders. Methods: We studied 2,786 men, born between 1934 and 1944 in Helsinki, Finland, who as conscripts at age 20 underwent an intellectual ability test comprising verbal, visuospatial (analogous to Raven's progressive matrices) and arithmetic reasoning subtests. We ascertained the later occurrence of coronary heart disease and stroke from validated national hospital discharge and death registers. Results: 281 men (10.1%) had experienced a coronary heart disease event and 131 (4.7%) a stroke event. Coronary heart disease was predicted by low scores in all subtests, hazard ratios for each standard deviation (SD) lower score ranging from 1.21 to 1.30 (confidence intervals 1.08 to 1.46). Stroke was predicted by a low visuospatial reasoning score, the corresponding hazard ratio being 1.23 (95% confidence interval 1.04 to 1.46), adjusted for year and age at testing. Adjusted in addition for the two other scores, the hazard ratio was 1.40 (1.10 to 1.79). This hazard ratio was little affected by adjustment for socioeconomic status in childhood and adult life, whereas the same adjustments attenuated the associations between intellectual ability and coronary heart disease. The associations with stroke were also unchanged when adjusted for systolic blood pressure at 20 years and reimbursement for adult antihypertensive medication. Conclusions: Stroke is predicted by low visuospatial reasoning scores in relation to scores in the two other subtests. This association may be mediated by common underlying causes such as impaired brain development, rather than by mechanisms associated with risk factors shared by stroke and coronary heart disease, such as socio-economic status, hypertension and atherosclerosis. - Funding: This study was supported by the Academy of Finland, the Paivikki and Sakari Sohlberg Foundation, the Finnish Diabetes Research Foundation, the Emil Aaltonen Foundation, the Finnish Foundation for Cardiovascular Research, the Finnish Foundation for Pediatric Research, the Finnish Medical Society Duodecim, the Jalmari and Rauha Ahokas Foundation, the Novo Nordisk Foundation, the Signe and Ane Gyllenberg Foundation, the Sigrid Juselius Foundation, the Yrjo Jahnsson Foundation, the Juho Vainio Foundation, and Finska Lakaresallskapet. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Children and young adults who gain lower scores in intellectual ability tests have shorter life expectancy [1,2,3,4,5,6,7] and a higher risk of coronary heart disease in later life [8,9,10,11,12,13,14]. Recent studies suggest that they also have a higher risk of stroke [8,10,14,15]. In some studies this association is at least as powerful as that for coronary heart disease, whereas other studies have shown a weaker association [8] or none at all [9]. Whether the predictive ability of low intellectual ability for coronary heart disease is different (...truncated)


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Eero Kajantie, Katri Räikkönen, Markus Henriksson, Jukka T. Leskinen, Tom Forsén, Kati Heinonen, Anu-Katriina Pesonen, Clive Osmond, David J. P. Barker, Johan G. Eriksson. Stroke Is Predicted by Low Visuospatial in Relation to Other Intellectual Abilities and Coronary Heart Disease by Low General Intelligence, PLOS ONE, 2012, 11, DOI: 10.1371/journal.pone.0046841