Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study.
Alexander E Merkler1, Traci M Bartz2, Hooman Kamel2
1From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY. alm9097@med.cornell.edu.
Silent myocardial infarction (MI) is a significant risk factor for ischemic stroke. This study found that even without symptoms, silent MI independently increases the risk of stroke, particularly nonlacunar types.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Silent myocardial infarction (MI) is an unrecognized cardiac event.
- The association between silent MI and subsequent ischemic stroke requires further investigation.
Purpose of the Study:
- To determine if silent MI is an independent risk factor for ischemic stroke.
- To evaluate the association between silent MI and ischemic stroke subtypes.
Main Methods:
- Prospective cohort study (Cardiovascular Health Study) of community-dwelling older adults (≥65 years).
- Participants without prevalent stroke or baseline MI were followed from 1989-1999.
- Silent MI defined by ECG changes without symptoms; overt MI included symptomatic events.
- Cox proportional hazards models analyzed the association between MI status and incident ischemic stroke, adjusting for confounders.
Main Results:
- Among 4,224 participants, silent MI occurred in 8.6% and overt MI in 10.0%.
- Silent MI was independently associated with a 51% increased risk of ischemic stroke (HR, 1.51; 95% CI, 1.03-2.21).
- Overt MI showed strong short-term and long-term associations with stroke; silent MI was linked to nonlacunar stroke (HR, 2.40; 95% CI, 1.36-4.22).
Conclusions:
- Silent myocardial infarction is an independent risk factor for ischemic stroke in older adults.
- Recognizing silent MI may improve stroke risk prediction and prevention strategies.
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