LAUSR

In this issue of the Journal, Lindgren and colleagues followed a cohort of over one million Swedish men from their late adolescence.1 They were enrolled in mandatory military conscription, during which they underwent a series of cognitive tests that examined their logical, verbal, visuospatial and technical ability. Lindgren et al. estimated the association of the performance in cognitive tests with the risk of incident heart failure (HF), using data from the Swedish Hospital Discharge Register. This study demonstrated that low cognitive performance in late adolescence was associated with an increased risk of HF and that the risk was greatest for men with the lowest level of cognitive functions.1 These results are well in line with a large body of evidence on the relationship between early-life cognitive skills and the development of cardiovascular disease,2 but novel in the HF literature. Interestingly, the study participants were on average as young as middle-aged at the time of their first hospitalization for HF. This is of interest because the burden of HF is increasing in some subgroups of young people and therefore the strategies to prevent HF would likely have the greatest impact if applied early in life.3 In the context of demographically aging populations, this article may also help us to better understand the relationship of the frequently co-occurring HF and cognitive impairment in the old age.4–7 Previous studies found that HF is associated with a damage in brain areas that could contribute to cognitive deficits, development of cognitive impairment as well as dementia including Alzheimer’s disease.8–11 Worse cognitive function was observed already at early stages of left ventricular dysfunction and furthermore, even in younger people without cardiovascular disease, there was an association between subclinical cardiac dysfunction and subtle injury of the brain.3,12 Two main theories emerged, explaining mechanisms of this complex relationship.4,5 First, cognitive impairment and HF could