Study Warns of Potential for Hastened Cognitive Decline Following Heart Attacks

Michelle C. Johansen, MD, PhD
Credit: Johns Hopkins Medicine

A new study from Johns Hopkins University School of Medicine is sounding the alarm on risk of declines in cognition, memory, and executive function following a heart attack.

An analysis of pooled data from 6 cohort studies, results of the study suggest incident myocardial infarction (MI) was not associate with a decrease in global cognition, memory, or executive function at the time of the event compared to no MI. However, investigators pointed out individuals with MI experienced more hastened declines in global cognition, memory, and executive function over time.

“We added to prior work investigating disability and dementia after MIby providing evidence that a decrease in cognition after incident MI was not sudden but happened more slowly over the years following the event and may have differed by race,” wrote investigators.

Led by Michelle C. Johansen, MD, PhD, along with colleagues from Columbia University, University of Miami, and others, the current study was launched with the intent of building upon the contemporary research base related to MI and cognitive function. To do so, investigators designed their study as an analysis of pooled data from US population-based cohort studies conducted form 1971-2019. The specific studies included in the analysis were Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study.

Overall, 30,465 adult patients were identified for inclusion. This cohort had a mean age of 64 (SD, 10) years, 56% were female. During a median follow-up of 6.4 (IQR, 4.9-19.7) years and, during the follow-up, 1033 had at least 1 MI event.

The primary outcome of interest was change in global cognition. Secondary outcomes of interest included changes in memory and executive function. Investigators noted use of linear mixed-effects models to estimate changes in function at the time of MI and the rate of cognitive change over the years after MI. Investigators pointed out these models were adjusted for pre-MI cognitive trajectories and participant factors.

Upon analysis, results indicated incident MI was not associated with an acute decrease in global cognition (−0.18 points [95% CI, −0.52 to 0.17]), executive function (−0.17 points [95% CI, −0.53 to 0.18]), or memory (0.62 points [95% CI, −0.07 to 1.31]). In contrast, those with a history of incident MI experienced faster declines in global cognition (−0.15 points per year [95% CI, −0.21 to −0.10]), memory (−0.13 points per year [95% CI, −0.22 to −0.04]), and executive function (−0.14 points per year [95% CI, −0.20 to −0.08]) over the years after MI compared with pre-MI slopes relative to their counterparts with no history of MI.

In an interaction analysis, results indicated race and sex modified the dredge of change in decline in global cogitation following MI (race × post-MI slope interaction term, P = .02; sex × post-MI slope interaction term, P = .04). Investigators highlighted a smaller change in the decline over the years after MI in Black individuals than among White Individuals (difference in slope change, 0.22 points per year [95% CI, 0.04-0.40]) and in females than in males (difference in slope change, 0.12 points per year [95% CI, 0.01-0.23]).

In an editorial comment, Eric Smith, MD, MPH, of the Department of Clinical Neurosciences and Hotchkiss Brain Institute at the University of Calgary, and Lisa Silbert, MD, of the Layton Oregon Alzheimer’s Disease Research Center at the Oregon Health and Science University, provided perspective on the findings, but also underlined the need for further research to examine the drivers of this hastened decline in cognitive function.

“What these epidemiological studies do not tell us is the reason for the post-MI acceleration in cognitive decline. Understanding the mechanisms for the post-MI decline may offer keys to identifying patients at risk and managing them to prevent decline,” wrote the pair.

References:

1. Johansen MC, Ye W, Gross A, et al. Association Between Acute Myocardial Infarction and Cognition. JAMA Neurol. Published online May 30, 2023. doi:10.1001/jamaneurol.2023.1331
2. Smith EE, Silbert LC. Myocardial Infarction Bends the Curve of Age-Related Cognitive Decline, but How? JAMA Neurol. Published online May 30, 2023. doi:10.1001/jamaneurol.2023.0466