Study warns of rising cognitive impairment following a heart attack

· News-Medical

In this study, researchers examined the potential relationship between a prior history of heart attack and the trajectory of cognitive function over time. The study included more than 20,000 adult men and women who underwent a medical interview and electrocardiogram at the start of the study to determine if they had a heart attack at any point in their past.

Over a 10-year follow-up period, participants underwent a simple cognitive screening with 6 questions once per year. The analysis adjusted for all factors that contribute to cognitive decline to identify the true impact of a prior heart attack.

The analysis found:

  • Compared to people without a previous heart attack, heart attack survivors had an average yearly 5 % increased odds of developing cognitive impairment. This association was similar among Black and white adults, as well as men and women.
  • People with an undiagnosed (silent) heart attack were also found to have an accelerated rate of cognitive decline, compared to participants who had not had a heart attack.
  • Among women, a silent heart attack was more common than a medical diagnosis or self-reported heart attack.

"As people age, the risk of cognitive issues and dementia increases, and some people may be at higher risk of cognitive decline. Our study found that those who have had a heart attack, including silent heart attacks, are one of those groups at higher risk. It's important for clinicians who care for heart attack survivors to also provide counseling on ways to avoid cognitive decline and dementia," Ridha said.

"A previous heart attack may be a sign of more widespread blood vessel disease throughout the body, not just in the heart. However, more research is needed to better understand what's really driving this connection and how damage in different blood vessels may be linked to changes in brain health." Marsh, who was not involved in this research, is a professor of neurology and associate director of the neurology residency program at The Johns Hopkins University School of Medicine and director of the Stroke Center at Johns Hopkins Bayview Medical Center in Baltimore.

Study details, background and design:

  • The analysis included health data for 20,923 men and women enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
  • Their average age was 63 years old, and 62% were white adults and 38% Black adults.
  • Participants were enrolled from 2003 to 2007 and had an electrocardiogram and no cognitive impairment at enrollment. REGARDS study data were collected from 2003 to 2017.
  • Evidence of a prior heart attack was identified in 10.4% of the participants: with 5.2% being self-reported, 1.3% confirmed by electrocardiogram (clinical), and 3.8% were unrecognized/silent heart attacks (no previous diagnosis of heart attack but evidence found on electrocardiogram). Participants were followed for a median of 10 years for cognitive decline.
  • The researchers adjusted for age, sex, race, geographic region in the U.S., education, income, exercise frequency, weight, blood pressure, kidney function, alcohol use, smoking, diabetes, depression, and any major cardiovascular events (stroke or heart attack) that occurred during the follow-up period.
  • The analysis examined the association between prior heart attack and change in overall cognitive function, assessed by annual telephone-based Six-Item Screener scores. The simple cognitive screening with 6 questions once per year. Participants were asked three orientation questions regarding the current year, month, and day of the week. They were then presented with three words (commonly "apple," "table," and "penny") and, after a short delay, asked to recall them. One point is assigned for each correct response, yielding a total score ranging from 0 to 6, with lower scores indicating worse cognitive performance.

Some limitations of the study may affect the results. The analysis reviewed data from an ongoing, prospective study that was designed to compare stroke incidence in the southeastern U.S., known as the stroke belt. Additionally, the cognitive test used is a simple six-question test that only measures overall cognition rather than specific brain and mental functions.

Sources:

American Heart Association

Journal reference:

Ridha, M., et al (2026). Prior Myocardial Infarction and Cognitive Decline: The REGARDS Cohort. Stroke. DOI:10.1161/STROKEAHA.125.053444. https://www.ahajournals.org/doi/10.1161/STROKEAHA.125.053444.