Key result
First-time MI is linked to ~13% higher 1-year dementia risk vs controls.
Why the study?
Ischemic heart disease and dementia share risk factors and potential cardiometabolic mechanisms, prompting investigation into the association between a first-time MI and the subsequent risks of dementia and mortality.
Cohort (n=524,272)
Yes
First-time myocardial infarction is associated with a slightly elevated early risk of dementia, though long-term dementia incidence appears lower due to a substantially higher competing risk of mortality after MI.
Early post-MI dementia risk elevation should not change practice; leaves open independent long-term association amid high competing mortality.
Background and purpose Ischemic heart disease and dementia share several risk factors, suggesting shared underlying pathophysiological mechanisms related to cardiometabolic disease. Given the increasing focus on dementia as a potential manifestation of the cardiometabolic disease spectrum, we investigated the association between a first-time myocardial infarction (MI) and the risk of dementia together with the risk of mortality. Methods Using Danish nationwide registries, we included all patients with a first-time MI without dementia from 1 January 1999 to 31 December 2023. Each patient was matched in a 1:2 ratio with controls without MI and dementia, by sex, birth year and index date. Patients were followed until diagnosis of dementia, death or end of study. We assessed the risk of all-cause dementia and mortality, using the Aalen-Johansen estimator to account for competing risk and censoring. Results A total of 174,772 patients with first-time MI and 349,500 controls were included (median age 69 years and 65% males). During the first years after MI, the risk of dementia was slightly higher in patients with MI compared to controls (1-year risk: 0.86% [95% CI: 0.81-0.90] versus 0.76% [95% CI: 0.74-0.79]). However, long-term risk of dementia appeared lower in patients with MI compared with controls likely due to the higher competing risk of mortality in patients with MI (Figure 1). Mortality was consistently higher among patients with MI, with 1- and 20-year risk of 16.36% (95% CI: 16.12-16.53) and 65.10% (95% CI: 64.77-65.43) versus 3.42% (95% CI: 3.36-3.48) and 52.59% (95% CI: 52.35-52.83) in controls. Conclusion First-time MI was associated with an elevated early risk of dementia. However, this association reversed over time with increasing age, as the competing risk of mortality became more dominant in patients with MI. Further investigation is needed to understand the trajectory after MI and to evaluate whether intensified risk factor management may reduce the risk of dementia.
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Pilavci et al. (2026) conducted a cohort in First-time myocardial infarction (n=524,272). First-time myocardial infarction vs. Matched controls without myocardial infarction or dementia was evaluated on 1-year risk of all-cause dementia. First-time MI was associated with higher 1-year dementia risk vs controls (0.86% vs 0.76%), though long-term dementia risk appeared lower due to higher 20-year mortality (65.10% vs 52.59%).
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