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

Covert brain infarction (CBI) increases the risk of atherosclerotic cardiovascular disease (ASCVD), but optimal clinical management is uncertain. To enable tailored preventive measures, we aimed to determine whether the co-occurrence of CBI with unrecognized myocardial infarction (UMI) identifies a subgroup at especially high risk of ASCVD.

We included participants from the population-based Rotterdam Study, who were aged ≥45 years and without a history of stroke, transient ischemic attack or myocardial infarction. Participants underwent electrocardiography and brain magnetic resonance imaging between 2006 and 2012 and were followed up for first-ever ASCVD (ie, composite of ischemic stroke and recognized myocardial infarction). We used Cox models adjusted for cardiovascular risk factors to determine ASCVD risk.

Among 4627 participants (mean age, 64.1 years; 57% women), 359 (7.8%) had CBI and 92 (2.0%) UMI. Compared with individuals without CBI, those with CBI were twice as likely to have UMI (odds ratio, 2.3 [95% CI, 1.2-3.9]). During a mean 9.9-year follow-up, 344 ASCVD events occurred. Compared with individuals with neither CBI nor UMI, individuals with CBI or UMI were at higher risk of ASCVD (hazard ratio [HR] for CBI, 1.7 [95% CI, 1.2-2.3]; and HR for UMI, 1.7 [95% CI, 0.9-3.3]), and individuals with co-occurring CBI and UMI were at highest risk (HR, 5.6 [95% CI, 2.9-10.7]). Among 359 individuals with CBI, those with UMI were at higher risk of ASCVD than those without UMI (HR, 3.4 [95% CI, 1.7-6.7]).

Individuals with CBI are at increased risk of ASCVD, particularly in the presence of co-occurring UMI. These findings mark a subgroup of patients with CBI that could benefit most from stringent preventive therapy.