A daughter helps her mother with exerciseShare on Pinterest
Experts say cognitive decline can develop slowly in the years after a heart attack. AsiaVision/Getty Images
  • New research indicates that a heart attack can cause more rapid decline in cognitive skills in the years after the incident.
  • Experts say that’s because heart and brain health are closely connected.
  • They say this is yet another reason for people to have heart healthy lifestyles.

Practicing good heart health doesn’t just keep heart attacks away.

It can also slow cognitive decline later in life.

That’s according to research being unveiled next week at the American Stroke Association’s International Stroke Conference 2022.

“We need to realize that what’s going on in the heart and brain are related. Managing risk factors to prevent a heart attack is actually good for your brain as well,” Dr. Michelle C. Johansen, lead author of the study and an assistant professor of cerebrovascular neurology at the Johns Hopkins University School of Medicine in Maryland, said in a statement.

“We have shown that having a heart attack can be detrimental to your brain health over time,” she added.

The study authors say their research is one of the first to examine the short-term and long-term impact of a sudden cardiac event on cognitive abilities.

The study included more than 31,000 participants, of which 56 percent were women, 23 percent were Black adults, 8 percent were Hispanic adults, and 69 percent were white adults.

The participants had not had a heart attack or been diagnosed with dementia. They were a median age of 60 when they received their first cognitive assessment.

The participants were followed for 5 to 20 years, with a median time of 6 years.

Researchers said the 1,047 subjects who had a heart attack didn’t have a significant decline in any measure of cognition soon afterward. Still, they did have significantly faster declines in memory, executive functioning, and global cognition in the years following the heart attack.

“Dementia is a slow, stepwise process,” Johansen said. “One doesn’t wake up out of the blue with dementia. If a heart attack is a factor in the development of dementia, you would not anticipate that, after adjusting for how sick a patient is, there would be cognitive decline immediately.

“However, we did find the significant change occurs several years later,” she added. “It’s important to know that cognitive decline is a possibility after a heart attack, so physicians are both managing patients’ heart disease and looking for signs of dementia following a heart attack. It can even be a great conversation starter about why it’s important for patients to follow medical advice to prevent a heart attack.”

Dr. Hannah I. Chaudry, a specialist in cardiovascular medicine at the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center Lebanon in New Hampshire, told Healthline that doctors have long known people having heart attacks can be predisposed to events such as strokes, which can lead to cognitive decline.

“But newer studies have found a general relationship between heart attacks and cognitive decline even in those without stroke,” Chaudry said. “This is a new finding, and further studies are needed to clarify the mechanisms behind this connection.”

Chaudry said there are two main ways heart disease can harm the brain.

“First, a heart attack threatens the brain directly by not pumping adequate amounts of blood to the brain,” she said. “This lack of blood flow can cause permanent brain injury that shows up later in life as cognitive decline.”

“Second, the fact that the heart arteries are diseased indicates that the same process may be occurring in the arteries of the brain and throughout the entire body,” Chaudry added. “We know that the same things that put one at risk for cholesterol buildup in the heart arteries leading to heart attack will increase the risk of buildup in the arteries of the brain. When this happens, the decreased blood flow to the brain can lead to eventual cognitive decline.

“It is still unclear why there is a delay in the appearance of cognitive decline following a heart attack. It is possible that the effects on the brain are very subtle initially, and we do not pick up on it until later in life,” she noted.

Dr. Alexandra Ward, director of Women’s Health Center at Riverside Health System in Virginia, told Healthline that cognitive decline in people after heart attacks is slower than those caused by a stroke.

She said this is “because this blood vessel blockage often occurs on a smaller scale compared to a stroke, which causes a huge decrease because it occurs in an artery or larger vessel.”

“The minor insults heart disease creates result in many people not seeing a decline until years later,” she said.

Ward said the risk factors associated with Alzheimer’s and dementia are also present for heart disease.

“I encourage everyone to be familiar with what I call the traditional factors in addition to gender-specific factors. Traditional factors that impact cardiac and vascular disease, which would lead to cognitive decline, include high blood pressure, high cholesterol, diabetes, smoking, (and) obesity,” she explained.

In women, Ward said other factors could include hypertension, preeclampsia, history of autoimmune disease, early menopause, anxiety, and depression.

“The biggest way to avoid heart attacks and cognitive decline is prevention against heart disease,” Ward said. “It’s important to first be aware of your risk factors and work with your healthcare team to aggressively reduce those.”

“This can include a heart-healthy diet, adequate exercise, adhering to blood pressure or cholesterol medication, and above all quitting smoking,” Ward said. “I tell my patients if they modify one aspect of their lifestyle, I highly recommend it is to quit smoking because of its tremendous benefits. Additionally, receiving the vaccination against the flu and COVID-19 continues to reduce the risk of additional infection, which can impact your heart.”