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Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis
Zien Zhou1, Shoujiang You1, Yuki Sakamoto1
1From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom.
Insights
Adults with heart disease have a high prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD). These conditions were similarly prevalent in those with or without a recent stroke, indicating a need for further research.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- Investigate the prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD) in adults with various heart conditions.
- Compare SBI and CSVD prevalence between individuals with and without a recent stroke.
- Explore associations between heart disease and the presence of SBI/CSVD.
Approach:
- Systematic literature search of Medline, Embase, and Cochrane Library for relevant observational studies.
- Meta-analysis of summary prevalence (95% confidence intervals) for SBI and CSVD subtypes.
- Calculation of pooled prevalence ratios to compare individuals with and without heart disease.
Key Points:
- High prevalence of SBI (36%) and CSVD subtypes (e.g., WMH 62%, microbleed 27%) observed in adults with heart disease.
- SBI and CSVD prevalence did not differ significantly between individuals with and without a recent stroke.
- Increased age and hypertension were associated with higher SBI and white matter hyperintensity (WMH) prevalence.
Conclusions:
- Individuals with heart disease exhibit a substantial burden of SBI and CSVD.
- The presence of recent stroke does not appear to alter SBI prevalence in this population.
- Further research is warranted to elucidate causal relationships and inform clinical management strategies.
Background And Objectives:
To determine the prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD) in adults with atrial fibrillation (AF), coronary artery disease, heart failure or cardiomyopathy, heart valve disease, and patent foramen ovale (PFO), with comparisons between those with and without recent stroke and an exploration of associations between heart disease and SBI/CSVD.
Methods:
Medline, Embase, and Cochrane Library were systematically searched for hospital-based or community-based studies reporting SBI/CSVD in people with heart disease. Data were extracted from eligible studies. Outcomes were SBI (primary) and individual CSVD subtypes. Summary prevalence (95% confidence intervals [CIs]) were obtained using random-effects meta-analysis. Pooled prevalence ratios (PRs) (95% CI) were calculated to compare those with heart disease with available control participants without heart disease from studies.
Results:
A total of 221 observational studies were included. In those with AF, the prevalence was 36% (31%-41%) for SBI (70 studies, N = 13,589), 25% (19%-31%) for lacune (26 studies, N = 7,172), 62% (49%-74%) for white matter hyperintensity/hypoattenuation (WMH) (34 studies, N = 7,229), and 27% (24%-30%) for microbleed (44 studies, N = 13,654). Stratification by studies where participants with recent stroke were recruited identified no differences in the prevalence of SBI across subgroups (phomogeneity = 0.495). Results were comparable across participants with different heart diseases except for those with PFO, in whom there was a lower prevalence of SBI [21% (13%-30%), 11 studies, N = 1,053] and CSVD. Meta-regressions after pooling those with any heart disease identified associations of increased (study level) age and hypertensives with more SBIs and WMH (pregression <0.05). There was no evidence of a difference in the prevalence of microbleed between those with and without heart disease (PR [95% CI] 1.1 [0.7-1.7]), but a difference was seen in the prevalence of SBI and WMH (PR [95% CI] 2.3 [1.6-3.1] and 1.7 [1.1-2.6], respectively).
Discussion:
People with heart disease have a high prevalence of SBI (and CSVD), which is similar in those with vs without recent stroke. More research is required to assess causal links and implications for management.
Trial Registration Information:
PROSPERO CRD42022378272 (crd.york.ac.uk/PROSPERO/).
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