Acute myocardial infarction is associated with faster age-related cognitive decline

To assess whether acute myocardial infarction (MI) is associated with changes in cognitive function, the study of Johansen et al. included individuals from six prospective cohort studies conducted in the USA from 1971 to 2019: Atherosclerosis Risk in Communities (ARIC) Study, Coronary Artery Risk Development in Young Adults (CARDIA) Study, Cardiovascular Health Study (CHS), Framingham Offspring Study (FHS), Multi-Ethnic Study of Atherosclerosis (MESA), and Northern Manhattan Study (NOMAS). 1 • The study included 30 465 individuals [age, 64 ± 10 years (mean ± SD)] without MI, stroke, or dementia at the time of the first cognitive assessment (69% White, 29% Black, and 56% female).Incident MI was recorded during follow-up.The primary outcome measure was a change in global cognition; secondary outcomes were changes in memory and executive function.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 potential confounders [educational level, waist circumference, body mass index, fasting glucose and lowdensity lipoprotein cholesterol (LDL-C) levels, mean systolic blood pressure (BP), use of antihypertensive medication, current smoking, alcohol consumption, physical activity, and history of atrial fibrillation (AF)], with interaction terms for race and sex.The median follow-up time was 6.4 years [interquartile range (IQR), 4.9-19.7 years].The average number of global cognitive assessments after incident MI was 2.6.The median time between incident MI and the first post-MI cognitive assessment was 1.9 years (IQR, 0.6-4.4years), with 398 individuals having their first cognitive test within 1 year after MI. • Overall, 1033 participants had one or more incident MI (137 participants had two MIs).Incident MI was not associated with an acute decrease in global cognition, memory, or executive function.Over long-term follow-up, individuals with incident MI experienced faster declines in global cognition [-0.15 points per year; 95% confidence interval (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.• 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 Black individuals than in White individuals and in females than in males.In people with a second MI, there was no acute drop in global cognition after the second MI, but there was an acute decrease in executive function.