{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:02:52Z","timestamp":1790334172687,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004772","name":"Natural Science Foundation of Ningxia Province","doi-asserted-by":"publisher","award":["2025AAC030727"],"award-info":[{"award-number":["2025AAC030727"]}],"id":[{"id":"10.13039\/501100004772","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp; Dementia"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>We assessed the association between cardiovascular disease (CVD) and cognitive decline in adults aged 50 years or older using pooled data from five multinational cohorts, quantified heterogeneity, and explored its potential sources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Individual\u2010level data from China Health and Retirement Longitudinal Study (CHARLS), Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, English Longitudinal Study of Ageing, and Mexican Health and Aging Study (83,159 adults \u226550 years) were pooled. Linear mixed models were used to estimate CVD\u2013cognitive decline associations, followed by random\u2010effects meta\u2010analysis. Heterogeneity was explored via descriptive stratification analyses, subgroup analyses, and sensitivity analyses. In supplementary analyses, we fitted time\u2010varying CVD models, mutually adjusted models for stroke and heart disease, and separate time\u2010varying models for stroke and heart disease as sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Substantial heterogeneity across cohorts in the association between CVD and cognitive decline (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a097.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) was observed. The stratification analyses\u00a0revealed\u00a0that CHARLS differed from the other four cohorts across multiple characteristics (region, sex, body mass index, and education). Subgroup and sensitivity analyses generally supported the main findings, although the association reversed in CHARLS when analyses were restricted to participants with CVD not taking medication. Additionally, heart disease correlated with accelerated cognitive decline across four Western cohorts, with heart disease\u2010to\u2010stroke ratios between 1.8:1 and 5.2:1, while stroke alone showed no significant link in any cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>The association between CVD and cognitive decline varies markedly across populations, with opposite directions observed between Chinese and Western cohorts. This heterogeneity may be partially explained by variations in the composition of heart disease and the use of medication across five cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71843","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:42:34Z","timestamp":1790044954000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heterogeneity in the association between cardiovascular disease and cognitive decline: a pooled analysis of five prospective cohort studies from 24 countries"],"prefix":"10.1002","volume":"22","author":[{"given":"Juanjuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Statistics School of Public Health at Ningxia Medical University  Yinchuan Ningxia People's Republic of China"},{"name":"People's Hospital of Ningxia Hui Autonomous Region  Yinchuan Ningxia People's Republic of 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Medical University  Yinchuan Ningxia People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics School of Public Health at Ningxia Medical University  Yinchuan Ningxia People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics School of Public Health at Ningxia Medical University  Yinchuan Ningxia People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Kou","sequence":"additional","affiliation":[{"name":"The Second People's Hospital of Shizuishan  Shizuishan Ningxia People's Republic of 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