Silent heart attack tied to increased risk for stroke

  • Merkler AE & al.
  • JAMA Neurol
  • 20 May 2019

  • International Clinical Digest
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Takeaway

  • Older adults who had imaging evidence of a prior myocardial infarction (MI) that was clinically unrecognized were 50% more likely to have cerebral infarction after other factors are taken into account.

Why this matters

Key results

  • 33.3% of cohort had brain MRI evidence of cerebral infarction.
  • Cardiac MRI results:
    • 23.9% had evidence of any MI,
    • 7.4% had evidence of recognized MI, and
    • 16.5% had evidence of unrecognized MI.
  • Participants had increased adjusted odds of cerebral infarction if they had:
    • Recognized MI (OR, 2.0; P=.01).
    • Unrecognized MI (OR, 1.5; P=.04).
  • Findings similar in sensitivity analyses adjusting for additional clinical factors and use of various medications.
  • Participants also had increased adjusted odds specifically of embolic infarcts of undetermined source if they had unrecognized MI (OR, 2.0; P=.02).

Study design

  • Icelandic cross-sectional cohort study of 925 community-dwelling older adults aged 67-93 years who underwent both brain MRI, late gadolinium enhancement cardiac MRI.
  • Main outcome: cerebral infarction on brain MRI (regardless of associated symptoms).
  • Funding: National Institutes of Health; others.

Limitations

  • Precise timing of MI, cerebral infarction not ascertainable.
  • Unmeasured confounding.
  • Too few clinically symptomatic strokes to assess associations.
  • Uncertain generalizability.

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