Risk of Cardiovascular Disease With Co-Occurring Covert Brain Infarction and Unrecognized Myocardial Infarction

Area of Science:

• Cardiology
• Neurology
• Preventive Medicine

Background:

• Covert brain infarction (CBI) is a known risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Optimal management strategies for patients with CBI remain unclear.
• The combined presence of CBI and unrecognized myocardial infarction (UMI) may indicate a particularly high-risk subgroup for ASCVD.

Purpose of the Study:

• To investigate whether the co-occurrence of CBI and UMI identifies a subgroup of patients at significantly higher risk of ASCVD.
• To inform tailored preventive strategies for individuals with CBI.

Main Methods:

• Utilized data from the population-based Rotterdam Study (n=4627, age ≥45).
• Participants without prior stroke or myocardial infarction underwent ECG and brain MRI.
• Cox models adjusted for cardiovascular risk factors were used to assess ASCVD risk over a mean 9.9-year follow-up.

Main Results:

• CBI was present in 7.8% and UMI in 2.0% of participants.
• Individuals with CBI had a higher likelihood of also having UMI (OR, 2.3).
• Co-occurring CBI and UMI conferred the highest ASCVD risk (HR, 5.6), significantly elevated compared to individuals with neither condition.

Conclusions:

• CBI is associated with increased ASCVD risk.
• The presence of UMI in individuals with CBI substantially amplifies ASCVD risk.
• This combined finding identifies a critical subgroup warranting aggressive preventive interventions.