Unrecognized myocardial infarction in relation to risk of dementia and cerebral small vessel disease.
OBJECTIVE
Men, but not women, with unrecognized myocardial infarction (MI) have an increased risk of cardiac events and stroke compared with those without MI or with recognized MI. We investigated whether unrecognized MI is also a risk factor for dementia and cerebral small vessel disease (white matter lesions and brain infarction) in 2 population-based cohort studies.


METHODS
In the Rotterdam Study, 6347 participants were classified at baseline (1990 to 1993) into those with recognized MI (subdivided into Q-wave and non-Q-wave MI), with unrecognized MI, and without MI based on electrocardiography and interview and were followed for incident dementia (n=613) until January 1, 2005. In the Rotterdam Scan Study, 436 nondemented persons were similarly classified based on electrocardiography and interview and underwent brain MRI for the assessment of white matter lesions and brain infarction.


RESULTS
In men, unrecognized MI was associated with an increased risk of dementia (compared with men without MI hazard ratio, 2.14; 95% CI, 1.37 to 3.35) and with more white matter lesions and more often brain infarction on MRI. In women, no associations were found with unrecognized MI. Recognized MI was not associated with the risk of dementia in either sex. Men, but not women, with recognized MI had more often any brain infarction or asymptomatic brain infarction, especially if they had Q-wave MI. No consistent associations were found between recognized Q-wave or non-Q-wave MI and severity of white matter lesions. Additional adjustment for cardiovascular risk factors did not change the results.


CONCLUSIONS
Men with unrecognized MI have an increased risk of dementia and more cerebral small vessel disease.
Ikram
M Arfan
MA
Department of Epidemiology & Biostatistics, Erasmus MC University Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
van Oijen
Marieke
M
de Jong
Frank Jan
FJ
Kors
Jan A
JA
Koudstaal
Peter J
PJ
Hofman
Albert
A
Witteman
Jacqueline C M
JC
Breteler
Monique M B
MM
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008833:Microcirculation / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors