Stroke
Prior heart attack linked to faster cognitive decline
Clinical Takeaway: Identifying any prior myocardial infarction may help flag patients at elevated risk for cognitive decline, supporting closer brain health follow-up and intensified vascular risk reduction.
Vascular contributions to dementia are increasingly recognized, but it has been less clear whether unrecognized or silent myocardial infarction (MI) carries the same long-term cognitive risk as a clinically recognized event. This analysis tested whether a pragmatic, real-world approach using self-reported history, plus a single ECG, could identify patients on a steeper cognitive trajectory.
Any evidence of prior MI was associated with 5% higher annual odds of incident cognitive impairment after adjustment for demographics, vascular risk factors, and interim cardiovascular events over a median 10 years of follow-up.
The signal held whether the heart attack had been clinically diagnosed or detected only on ECG. The excess annual decline on a six-item screening test was similar across all three subtypes: self-reported MI (history without Q-wave), clinical MI (history plus Q-wave), and silent MI (Q-wave without a known diagnosis). A Q-wave is an ECG marker of prior heart muscle damage and can persist long after the original event.
People with self-reported MI declined across executive function, learning, and memory, which is a pattern more typical of vascular dementia. Those with clinical MI showed an isolated memory decline more consistent with Alzheimer disease. Silent MI accounted for 36.8% of all prior infarctions in the cohort and was associated with accelerated decline in both sexes, broadening earlier findings that had largely been limited to men.
Researchers analyzed 20,923 adults age 45 and older in the REGARDS cohort, enrolled from 2003 to 2007 with no baseline cognitive impairment, who completed annual telephone-based cognitive screening through 2017. ECG misses some silent MIs that cardiac MRI detects more sensitively, and higher mortality among MI survivors may have led to underestimating the true cognitive effect.
The findings support using something as simple as an ECG plus a few interview questions to identify patients whose brains, not just their hearts, may benefit from sustained attention. Whether silent MI drives cognitive decline through the same mechanisms as recognized MI, including microvascular disease, subclinical cerebral infarcts, inflammation, or impaired amyloid clearance, remains unresolved.
"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," said lead author Mohamed Ridha, MD, assistant professor of neurology at The Ohio State University in Columbus.
Source: Ridha M. Stroke. 2026 May 14. Prior Myocardial Infarction and Cognitive Decline: The REGARDS Cohort