@article {9377, title = {Association Between Acute Myocardial Infarction and Cognition.}, journal = {JAMA Neurol}, year = {2023}, month = {2023 May 30}, abstract = {

IMPORTANCE: The magnitude of cognitive change after incident myocardial infarction (MI) is unclear.

OBJECTIVE: To assess whether incident MI is associated with changes in cognitive function after adjusting for pre-MI cognitive trajectories.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults without MI, dementia, or stroke and with complete covariates from the following US population-based cohort studies conducted from 1971 to 2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Data were analyzed from July 2021 to January 2022.

EXPOSURES: Incident MI.

MAIN OUTCOMES AND MEASURES: The main outcome was change in global cognition. Secondary outcomes were changes in memory and executive function. Outcomes were standardized as mean (SD) T scores of 50 (10); a 1-point difference represented a 0.1-SD difference in cognition. 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 participant factors, with interaction terms for race and sex.

RESULTS: The study included 30 465 adults (mean [SD] age, 64 [10] years; 56\% female), of whom 1033 had 1 or more MI event, and 29 432 did not have an MI event. Median follow-up was 6.4 years (IQR, 4.9-19.7 years). Overall, incident MI was not associated with an acute decrease in global cognition (-0.18 points; 95\% CI, -0.52 to 0.17 points), executive function (-0.17 points; 95\% CI, -0.53 to 0.18 points), or memory (0.62 points; 95\% CI, -0.07 to 1.31 points). However, individuals with incident MI vs those without MI demonstrated faster declines in global cognition (-0.15 points per year; 95\% CI, -0.21 to -0.10 points per year), memory (-0.13 points per year; 95\% CI, -0.22 to -0.04 points per year), and executive function (-0.14 points per year; 95\% CI, -0.20 to -0.08 points per year) 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 {\texttimes} post-MI slope interaction term, P = .02; sex {\texttimes} post-MI slope interaction term, P = .04), with a smaller change in the decline over the years after MI in Black individuals than in White individuals (difference in slope change, 0.22 points per year; 95\% CI, 0.04-0.40 points per year) and in females than in males (difference in slope change, 0.12 points per year; 95\% CI, 0.01-0.23 points per year).

CONCLUSIONS: This cohort study using pooled data from 6 cohort studies found that incident MI was not associated with a decrease in global cognition, memory, or executive function at the time of the event compared with no MI but was associated with faster declines in global cognition, memory, and executive function over time. These findings suggest that prevention of MI may be important for long-term brain health.

}, issn = {2168-6157}, doi = {10.1001/jamaneurol.2023.1331}, author = {Johansen, Michelle C and Ye, Wen and Gross, Alden and Gottesman, Rebecca F and Han, Dehua and Whitney, Rachael and Brice{\~n}o, Emily M and Giordani, Bruno J and Shore, Supriya and Elkind, Mitchell S V and Manly, Jennifer J and Sacco, Ralph L and Fohner, Alison and Griswold, Michael and Psaty, Bruce M and Sidney, Stephen and Sussman, Jeremy and Yaffe, Kristine and Moran, Andrew E and Heckbert, Susan and Hughes, Timothy M and Galecki, Andrzej and Levine, Deborah A} } @article {9437, title = {Prediction of Multiple Individual Primary Cardiovascular Events Using Pooled Cohorts.}, journal = {medRxiv}, year = {2023}, month = {2023 Aug 02}, abstract = {

INTRODUCTION: Most current clinical risk prediction scores for cardiovascular disease prevention use a composite outcome. Risk prediction scores for specific cardiovascular events could identify people who are at higher risk for some events than others informing personalized care and trial recruitment. We sought to predict risk for multiple different events, describe how those risks differ, and examine if these differences could improve treatment priorities.

METHODS: We used participant-level data from five cohort studies. We included participants between 40 and 79 years old who had no history of myocardial infarction (MI), stroke, or heart failure (HF). We made separate models to predict 10-year rates of first atherosclerotic cardiovascular disease (ASCVD), first fatal or nonfatal MI, first fatal or nonfatal stroke, new-onset HF, fatal ASCVD, fatal MI, fatal stroke, and all-cause mortality using established ASCVD risk factors. To limit overfitting, we used elastic net regularization with alpha = 0.75. We assessed the models for calibration, discrimination, and for correlations between predicted risks for different events. We also estimated the potential impact of varying treatment based on patients who are high risk for some ASCVD events, but not others.

RESULTS: Our study included 24,505 people; 55.6\% were women, and 20.7\% were non-Hispanic Black. Our models had C-statistics between 0.75 for MI and 0.85 for HF, good calibration, and minimal overfitting. The models were least similar for fatal stroke and all MI (0.58). In 1,840 participants whose risk of MI but not stroke or all-cause mortality was in the top quartile, we estimate one blood pressure-lowering medication would have a 2.4\% chance of preventing any ASCVD event per 10 years. A moderate-strength statin would have a 2.1\% chance. In 1,039 participants who had top quartile risk of stroke but not MI or mortality, a blood pressure-lowering medication would have a 2.5\% chance of preventing an event, but a moderate-strength statin, 1.6\%.

CONCLUSION: We developed risk scores for eight key clinical events and found that cardiovascular risk varies somewhat for different clinical events. Future work could determine if tailoring decisions by risk of separate events can improve care.

}, doi = {10.1101/2023.08.01.23293525}, author = {Sussman, Jeremy B and Whitney, Rachael T and Burke, James F and Hayward, Rodney A and Galecki, Andrzej and Sidney, Stephen and Allen, Norrina Bai and Gottesman, Rebecca F and Heckbert, Susan R and Longstreth, William T and Psaty, Bruce M and Elkind, Mitchell S V and Levine, Deborah A} }