Heart Attacks Linked to Faster Cognitive Decline

Importance  

The magnitude of cognitive change after an incident myocardial infarction (MI) is unclear.

Aim  

To evaluate whether incident MI is associated with changes in cognitive function after adjusting for pre-MI cognitive trajectories.

Design, environment and participants  

This cohort study included adults without myocardial infarction, dementia, or stroke and with complete covariates from the following US population-based cohort studies conducted between 1971 and 2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Atherosclerosis Study, and Northern Manhattan Study. Data was analyzed from July 2021 to January 2022.

Exhibitions

Incident acute myocardial infarction.

Main results and measures  

The main result was the change in global cognition . Secondary outcomes were changes in memory and executive function. Results were standardized as mean (SD) T scores of 50 (10); a difference of 1 point represented a difference of 0.1 SD in cognition. Linear mixed-effects models estimated changes in cognition at the time of MI (change in intercept) and the rate of cognitive change over the years after MI (change in slope), controlling for pre-MI cognitive trajectories and participant factors, with interaction terms for race and sex.

Results 

The study included 30,465 adults (mean [SD] age, 64 ± 10 years; 56% women), of whom 1,033 had 1 or more MI events and 29,432 had no MI events. Median follow-up was 6.4 years (IQR, 4.9-19.7 years).

Overall, incident MI was not associated with an acute decline in global cognition (−0.18 points; 95% CI, −0.52 to 0.17 points), executive function (−0.17 points; 95% CI, −0.53 to 0.18 points) or memory (0.62 points; 95% CI, −0.07 to 1.31 points).

However, people with incident MI versus those without MI demonstrated more rapid declines in global cognition (−0.15 points per year; 95% CI, −0.21 to −0.10 points per year). year), memory (−0.13 points per year; 95% CI, − 0.22 to −0.04 points per year), and executive function (−0.14 points per year; 95% CI, − 0.20 to −0.08 points per year) during post-MI years compared to pre-MI slopes.p = 0.02; sex × post-MI slope interaction term, P = 0.04), with a smaller change in decline over the years post-MI in black individuals than in white individuals (difference in slope change, 0.22 points per year; 95% CI, 0.04 -0.40 points per year) and in women than in men (difference in slope change, 0.12 points per year; 95% CI %, 0.01-0.23 points per year).

Conclusions  

This cohort study using pooled data from 6 cohort studies found that incident MI was not associated with a decline in global cognition, memory, or executive function at the time of the event compared with no MI, but was associated with more rapid declines in global cognition, memory, and executive function over time . These findings suggest that preventing myocardial infarction may be important for long-term brain health.

Comments

In a recent study, a Johns Hopkins Medicine researcher and colleagues analyzed data from adults to determine whether there is a relationship between having a heart attack and cognitive decline. The new findings, published May 30, 2023, in JAMA Neurology , showed that having a heart attack, among those who had never had one before, was not associated with a sudden decline in cognition. But, for those who had a heart attack compared to those who did not, there was a significantly faster decline in cognition in the years after the heart attack. The decline in global cognition after a heart attack was equivalent to between six and 13 years of cognitive aging.

According to the Centers for Disease Control and Prevention, about 805,000 people in the United States suffer a heart attack each year. Of these, 605,000 are a first heart attack and 200,000 happen to people who have already had a heart attack.

“Due to the fact that many people are at risk of suffering a heart attack, we hope that the results of our study serve as a wake-up call for people to control vascular risk factors such as high blood pressure and high cholesterol as much as possible.” as soon as possible, as we have shown that having a heart attack increases the risk of decreased cognition and memory later in life,” says Michelle Johansen, M.D., Ph.D., associate professor of neurology at the School of Medicine. from Johns Hopkins University.

In a combined analysis of six different large studies of adults between 1971 and 2019, researchers determined whether people who had heart attacks showed changes in cognition compared to people similar to them in all ways except that they had not had an attack. cardiac. The researchers used a point system to measure participants’ global or general cognition over time, as well as memory and executive functioning, or how well people make complex cognitive decisions.

For those who suffered a heart attack, although researchers did not find significant cognitive decline immediately after their first heart attack, participants’ cognitive tests showed decline over the years following the event . Scores from several different cognitive tests were combined to represent a cognitive domain. A decrease in points indicated a decrease in that cognitive domain.

The study sample consisted of 30,465 people who had not had a heart attack or stroke and who did not have dementia at the time of the first cognitive evaluation; 29% of the individuals were black, 8% were Hispanic, and 56% were women. Of the overall sample, 1,033 people had at least one heart attack, and of that, 137 had two heart attacks. People who had heart attacks were more likely to be men and older.

Johansen says the next steps are to look at other aspects of heart health and how they may affect brain health.

“We have shown that heart attack prevention can be a strategy to preserve brain health in older adults,” says Johansen. “Now we need to determine what specifically is causing cognitive decline over time.”

This research was supported by the National Institute of Neurological Disorders and Stroke (R01 NS102715; principal investigator, Deborah A. Levine, MD, MPH, University of Michigan), the National Institutes of Health, and the Department of Health and Human Services.