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Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study.
Tuesday,2021-07-20 16:35 America/Los_Angeles — ecterry
| Title | Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2021 |
| Authors | Merkler, AE, Bartz, TM, Kamel, H, Soliman, EZ, Howard, V, Psaty, BM, Okin, PM, Safford, MM, Elkind, MSV, Longstreth, WT |
| Journal | Neurology |
| Date Published | 2021 May 24 |
| ISSN | 1526-632X |
| Abstract | <p><b>OBJECTIVE: </b>To test the hypothesis that silent MI is a risk factor for ischemic stroke, we evaluated the association between silent MI and subsequent ischemic stroke in the Cardiovascular Health Study.</p><p><b>METHODS: </b>The Cardiovascular Health Study prospectively enrolled community-dwelling individuals ≥65 years of age. We included participants without prevalent stroke or baseline evidence of MI. Our exposures were silent and clinically apparent, overt MI. Silent MI was defined as new evidence of Q-wave MI, without clinical symptoms of MI, on ECGs performed during annual study visits from 1989-1999. The primary outcome was incident ischemic stroke. Secondary outcomes were ischemic stroke subtypes: non-lacunar, lacunar, and other/unknown. Cox proportional hazards analysis was used to model the association between time-varying MI status (silent, overt, or no MI) and stroke after adjustment for baseline demographics and vascular risk factors.</p><p><b>RESULTS: </b>Among 4,224 participants, 362 (8.6%) had an incident silent MI, 421 (10.0%) an incident overt MI, and 377 (8.9%) an incident ischemic stroke during a median follow-up of 9.8 years. After adjustment for demographics and comorbidities, silent MI was independently associated with subsequent ischemic stroke (HR, 1.51; 95% CI, 1.03-2.21). Overt MI was associated with ischemic stroke both in the short term (HR, 80; 95% CI, 53-119) and long term (HR, 1.60; 95% CI, 1.04-2.44). In secondary analyses, the association between silent MI and stroke was limited to non-lacunar ischemic stroke (HR 2.40; 95% CI, 1.36-4.22).</p><p><b>CONCLUSION: </b>In a community-based sample, we found an association between silent MI and ischemic stroke.</p> |
| DOI | 10.1212/WNL.0000000000012249 |
| Alternate Journal | Neurology |
| PubMed ID | 34031202 |
ePub date:
21/05