Incident Myocardial Infarction Tied to Faster Cognitive Decline Over Time

Incident myocardial infarction (MI) has no association with a decline in cognition, memory, and executive function immediately following the event. However, it can result in a faster cognitive decline over time. These are the findings of a study published in JAMA Neurology.

Research has shown that MI is associated with dementia and cognitive decline; but, the magnitude and trajectory of cognitive changes are not well-documented. For the study, researchers sought to determine the association between incident MI and changes in cognitive function. 

The study population included patients from 6 US prospective cohort studies that ran from 1971 to 2019: the Atherosclerosis Risk in Communities (ARIC) Study, Coronary Artery Risk Development in Young Adults Study (CARDIA), Cardiovascular Health Study (CHS), Framingham Offspring Study (FHS), Multi-Ethnic Study of Atherosclerosis (MESA), and Northern Manhattan Study (NOMAS). Patients with a history of MI, dementia, or stroke at baseline were excluded from the study. Some other exclusion criteria were missing blood pressure measurements before the first cognitive assessment and lack of data regarding covariates of interest. 

The primary study outcome was the change in global cognition. The secondary outcomes were changes in memory and executive function. Incident MI was determined during the follow-up period. 

A total of 40,016 participants were identified from the 6 studies. After exclusion, 30,465 individuals remained, with an average age of 64 years (standard deviation [SD], 10 years). Of these patients, 56% were women, 69% were White, 29% were Black, and 8% were Hispanic. There were 1,033 patients who had 1 or more incident MI events and 137 had 2 MI events. 

When adjusting for a decline in cognition following MI, there were no significant associations with MI and 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). 

Long-term follow-up revealed that patients with at least 1 MI event showed a faster decline in global cognition (-0.15 points per year; 95% CI, -0.21 to -0.10 points per 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).

The interaction analysis revealed the potential for race and sex to influence the trajectory of change in the decline of global cognition following MI. This analysis suggested that the change in cognitive decline following MI was smaller for Black participants than White participants and smaller in women than in men. 

“Discussion of the potential cognitive ramifications of MI should be considered as a potential motivator when counseling patients at risk for MI,” the researchers wrote. “Additionally, individuals who have experienced an MI should be followed up for accelerated cognitive decline in the years after MI.”

Study limitations included the potential underestimation of acute cognitive changes immediately following the event, lack of data on incident dementia, and the inability to assess additional socioeconomic factors. 

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.

This article originally appeared on Neurology Advisor