Silent Heart Disease Should Be Considered in Stroke Patients

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NEW YORK (Reuters Health) Sept 08 - All patients with ischemic stroke or transient ischemic attacks should have their cardiovascular risk determined, according to a statement released on Monday by the American Heart Association (AHA) and the American Stroke Association. Silent cardiac ischemia is seen in up to 40% of such patients.

"There are data to indicate that some people already have significant heart disease by the time they have a stroke even though they don't have any recognized symptoms of heart disease," lead author Dr. Robert J. Adams, past chairman of the AHA's Stroke Council Leadership Committee, said in a statement.

Therefore, it is important that physicians know how to approach coronary risk in healthy stroke patients with no symptoms or history of heart disease, he added.

As reported in the September 9th issue of Circulation: Journal of the AHA, Dr. Adams' team reviewed the literature to determine the short- and long- term outcomes of stroke survivors.

Within 2 years of stroke, up to 5% of patients experienced a myocardial infarction, the authors found. Such patients, however, were at greater risk for experiencing a second stroke.

"The risk of fatal heart attack compared to having another stroke is relatively modest, but it's important and we want to take it seriously and consider testing to reduce risk in some cases," Dr. Adams, from the Medical College of Georgia in Augusta, noted.

With longer follow-up, however, the researchers found that the risk of heart disease was equal to, and sometimes exceeded, the risk of recurrent stroke. In fact, 24% to 45% of deaths were related to non-stroke vascular disease.

The risk of heart disease was higher with large- rather than small-vessel strokes, the findings indicate. "This stands to reason because coronary disease is large-artery disease of the heart," Dr. Adams noted.

Base on these findings, the authors recommend that stroke patients with several cardiovascular risk factors, symptoms of brain ischemia, or large-vessels strokes be considered for noninvasive heart disease testing. Evaluation and treatment of coronary disease should be based on current practice guidelines, they add.

Circulation 2003; 108:000-000;doi:10.1161/01.CIR..0000086927.40526.F7.