27 May Silent Heart Attack Associated with Increased Risk of Embolic Stroke
MedicalResearch.com Interview with:
Lenore J. Launer, PhD.
Chief Neuroepidemiology Section Intramural Research Program
National Institute on Aging
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The prevalence of cerebral infarction on MRI can be as high as 30% in community-based studies. These lesions detected on brain MRI, are often clinically silent, but are associated with impairments in cognitive and physical function and can increase the risk for clinical events. For a large number, the origin of these brain lesions is unknown. There is also a lack of population-based data on unrecognized myocardial infarction, which is associated with an increased for clinical coronary disease and mortality.
Unrecognized MI was detected in 17% of participants using state-of-the-art cardia MRI, a more sensitive measure of the lesions, than the standard ECG. We investigated the contribution to these lesions of recognized and unrecognized myocardial infarction [MI] identified on cardiac MRI.
We found both recognized and unrecognized myocardial infarction increased the risk for cerebral infarction, and that in particular unrecognized MI was associated with cerebral infarction of embolic origins of an unknown source. Given their prevalence, unrecognized MI may be an underestimated contributor to the risk for cerebral infarction in older persons.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings provide further evidence of the link between coronary disease and brain disease. These diseases by standards of care, are often treated by different medical specialties. However, this study and other on-going research suggests integrated investigations of heart and brain disease are needed.
The study also highlights the importance of ‘silent’ disease, which is less often identified in the context of more devastating clinical disease. [Sub]-clinical infarction in both the heart and the brain were detected by MRI. Studies show that these ‘clinically silent’ lesions may also increase the risk, or portend, more severe disease and may in less obvious ways, reduce the quality of an individual’s life.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The study also provides additional evidence that further research is needed on the use of MRI to detect pathology in the brain and heart. Such research could include the gain in detection of disease compared to cost, in describing the pathophysiology underlying future cardio-cerebral events, and to identifying targeted prevention and treatment strategies to improve quality of life, and to reduce the risk of clinical disease, and mortality.
Merkler AE, Sigurdsson S, Eiriksdottir G, et al. Association Between Unrecognized Myocardial Infarction and Cerebral Infarction on Magnetic Resonance Imaging. JAMA Neurol. Published online May 20, 2019. doi:10.1001/jamaneurol.2019.1226
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