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Higher Risk of Vascular Dementia in Myocardial Infarction Survivors
Jens Sundbøll1,2, Erzsébet Horváth-Puhó3, Kasper Adelborg3,2
1Department of Clinical Epidemiology (J.S., E.H.-P., K.A., M.S., L.P., V.W.H., H.T.S.) jens.sundboll@clin.au.dk.
Insights
Myocardial infarction (MI) survivors face an increased risk of vascular dementia, especially if they experience stroke. However, MI does not elevate the risk for Alzheimer disease or other dementias.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- Myocardial infarction (MI) survivors may have an increased risk of dementia due to shared risk factors like atherosclerosis and post-MI stroke.
- Investigating the specific dementia risks following MI is crucial for understanding long-term health outcomes.
Purpose of the Study:
- To examine the association between myocardial infarction (MI) and the subsequent risk of developing dementia in 1-year survivors.
- To differentiate the risk of various dementia subtypes (Alzheimer disease, vascular dementia, other dementias) after MI.
Main Methods:
- A nationwide population-based cohort study using Danish medical registries from 1980-2012.
- Included first-time MI patients and a matched general population comparison cohort (n=314,911 MI; n=1,573,193 controls).
- Cox regression analysis calculated adjusted hazard ratios (aHRs) for dementia over 35 years, controlling for comorbidities and socioeconomic status.
Main Results:
- Myocardial infarction (MI) was not associated with an increased risk of all-cause dementia (aHR, 1.01).
- The risk of Alzheimer disease (aHR, 0.92) and other dementias was similar to the general population.
- MI was associated with a significantly higher risk of vascular dementia (aHR, 1.35), particularly in patients who experienced stroke post-MI (aHR, 4.48).
Conclusions:
- Myocardial infarction (MI) is linked to a heightened risk of vascular dementia, with the risk substantially amplified by post-MI stroke.
- The risk for Alzheimer disease and other dementia types remains unchanged in individuals with a history of MI.
Background:
Increased risk of dementia after myocardial infarction (MI) may be mediated by shared risk factors (eg, atherosclerosis) and post-MI stroke. We examined risk of dementia in 1-year survivors of MI.
Methods:
Using Danish medical registries, we conducted a nationwide population-based cohort study of all patients with first-time MI and a sex-, birth year-, and calendar year-matched general population comparison cohort without MI (1980-2012). Cox regression analysis was used to compute 1- to 35-year adjusted hazard ratios (aHRs) for dementia, controlled for matching factors and adjusted for comorbidities and socioeconomic status.
Results:
We identified 314 911 patients with MI and 1 573 193 matched comparison cohort members randomly sampled from the general population (median age, 70 years; 63% male). After 35 years of follow-up, the cumulative incidence of all-cause dementia in the MI cohort was 9% (2.8% for Alzheimer disease, 1.6% for vascular dementia, and 4.5% for other dementias). Compared with the general population cohort, MI was not associated with all-cause dementia (aHR, 1.01; 95% confidence interval [CI], 0.98-1.03). Risk of Alzheimer disease (aHR, 0.92; 95% CI, 0.88-0.95) and other dementias (aHR, 0.98; 95% CI, 0.95-1.01) also approximated unity. However, MI was associated with higher risk of vascular dementia (aHR, 1.35; 95% CI, 1.28-1.43), which was substantially strengthened for patients experiencing stroke after MI (aHR, 4.48; 95% CI, 3.29-6.12).
Conclusions:
MI was associated with higher risk of vascular dementia throughout follow-up, and this association was stronger in patients with stroke. The risk of Alzheimer disease and other dementias was not higher in patients with MI.
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