Association Between Acute Myocardial Infarction and Cognition

Abstract

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

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

Design, setting, and participants: This cohort study included adults without MI, dementia, or stroke and with complete covariates from the following US population-based cohort studies conducted from 1971 to 2019: 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. Data were analyzed from July 2021 to January 2022.

Exposures: Incident MI.

Main outcomes and measures: The main outcome was change in global cognition. Secondary outcomes were changes in memory and executive function. Outcomes were standardized as mean (SD) T scores of 50 (10); a 1-point difference represented a 0.1-SD difference in cognition. Linear mixed-effects models estimated changes in cognition at the time of MI (change in the intercept) and the rate of cognitive change over the years after MI (change in the 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% female), of whom 1033 had 1 or more MI event, and 29 432 did not have an MI event. Median follow-up was 6.4 years (IQR, 4.9-19.7 years). Overall, incident MI was not associated with an acute decrease 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, individuals with incident MI vs those without MI demonstrated faster declines 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) over the years after MI compared with pre-MI slopes. The interaction analysis suggested that race and sex modified the degree of change in the decline in global cognition after MI (race × post-MI slope interaction term, P = .02; sex × post-MI slope interaction term, P = .04), with a smaller change in the decline over the years after 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 females than in males (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 decrease in global cognition, memory, or executive function at the time of the event compared with no MI but was associated with faster declines in global cognition, memory, and executive function over time. These findings suggest that prevention of MI may be important for long-term brain health.

Figure 1.. Estimated Values of Cognition for the Association Between Incident MI and Change in Global Cognition, Executive Function, and Memory Acutely and in the Years Following the Myocardial Infarction (MI) Event Among 30 465 Participants

Global cognition measures global cognitive performance. All cognitive measures were set to a mean (SD) T score metric (50 [10]) at a participant’s first cognitive assessment; a 1-point difference represented a 0.1-SD difference in the distribution of the specified cognitive domain across the 6 cohorts. Higher cognitive scores indicate better performance. Cognitive observations were censored after stroke. Graphs represent a patient who is aged 70 years with a high school education and is a nonsmoker with no alcohol use, no history of atrial fibrillation, no physical activity, no antihypertensive medication use, a body mass index of 27 (calculated as weight in kilograms divided by height in meters squared), a waist circumference of 96 cm, a fasting blood glucose level of 97 mg/dL (to convert to millimoles per liter, multiply by 0.0555), a low-density lipoprotein cholesterol level of 123 mg/dL (to convert to millimoles per liter, multiply by 0.0259), and a cumulative systolic blood pressure of 135 mm Hg.

Figure 2.. Estimated Values of Global Cognition for Differences by Race or by Sex in the Association Between Incident Myocardial Infarction (MI) and Change in Global Cognition Among 30 465 Participants

A, Sex was held constant (P = .02 for differences between race in acute decline after MI; P = .02 for difference between race in long-term cognitive slope change after MI). B, P = .02 for difference between race in acute decline after MI; P = .02 for differences between race in long-term cognitive slope change after MI). C, Race was held constant (P = .27 for differences in sex in acute decline after MI; P = .04 for differences in sex in long-term cognitive slope change after MI). D, P = .27 for difference in sex in acute decline after MI; P = .04 for differences in sex in long-term cognitive slope change after MI). Global cognition measures global cognitive performance. All cognitive measures were set to a mean (SD) T score metric (50 [10]) at a participant’s first cognitive assessment; a 1-point difference represented a 0.1-SD difference in the distribution of the specified cognitive domain across the 6 cohorts. Higher cognitive scores indicate better performance. Cognitive observations were censored after stroke. Graphs represent a patient who is aged 70 years with a high school education and is a nonsmoker with no alcohol use, no history of atrial fibrillation, no physical activity, no antihypertensive medication use, a body mass index of 27 (calculated as weight in kilograms divided by height in meters squared), a waist circumference of 96 cm, a fasting blood glucose level of 97 mg/dL (to convert to millimoles per liter, multiply by 0.0555), a low-density lipoprotein cholesterol level of 123 mg/dL (to convert to millimoles per liter, multiply by 0.0259), and a cumulative systolic blood pressure of 135 mm Hg.