Association of MI and cognitive decline @ יואל קסלר
In this post " Association of MI and cognitive decline @ יואל קסלר" we reprint data from JAMA Neurology by Johansen et. al. that shows an increased risk for the development of cognitive decline following a myocardial infarction. The full article can be found here.
במאמר זה ב יואל קסלר .קום "ירידה קוגניטיבית קשורה לאוטם שריר הלב" אנו מציגים מחקר חדש המצביע על כך שחולים עם אוטם שריר הלב עשויים להיות בסיכון בטווח הארוך של ירידה קוגניטיבית מואצת.
Association Between Acute Myocardial Infarction and Cognition
Michelle C. Johansen, MD, PhD1; Wen Ye, PhD2; Alden Gross, PhD1; et al
Key Points
Question Is myocardial infarction (MI) associated with cognition acutely after MI or in the years following MI?
Findings In this cohort study of 30 465 adults without MI, stroke, or dementia, overall, incident MI was not associated with an acute decrease in global cognition, memory, or executive function at the time of the event compared with no MI. The rate of decline in global cognition, memory, and executive function was significantly faster over the years for adults with an MI event compared with those without an MI.
Meaning These findings suggest that prevention of MI may be important for long-term brain health.
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.
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