Compared with patients with migraine and other transient neurological events, those with an ischemic stroke have almost double the risk for myocardial infarction (MI) within a year, while those with cervical artery dissection (CeAD) alone show no heightened risk, preliminary results of new research showed.
“These findings suggest CeAD might be less severe in the context of cardiovascular disease; if CeAD doesn’t co-occur with or cause a stroke, then the future risk of MI appears comparable to that of our selected control group,” study author Liqi Shu, MD, clinical fellow in Vascular Neurology, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, told theheart.org | Medscape Cardiology.
The findings will be presented at the American Stroke Association’s International Stroke Conference (ISC) 2024 to be held in Phoenix, Arizona, on February 7-9, 2024.
Research shows both aortic dissection and stroke are associated with subsequent MI, and although “people kind of assumed” CeAD is not associated with higher MI risk, “there is limited if any data to support this,” said Shu.
One of the concerns has been that the cervical arteries, carotid or vertebral arteries, are associated with aortic disease, said Shu. “So, people were not quite sure if a cervical artery tear carries a high risk of MI.”
New York, Florida Inpatient Data
Researchers used the State Inpatient Database (SID) from New York (2011-2017) and Florida (2011-2019) to examine MI risk post stroke or CeAD. The only other US state with an SID is California, but those data were too limited to be useful in the current analysis, they noted.
Still, New York and Florida account for over 10% of the US population and provide a good representation of diverse demographic groups, they added.
The study included 711,228 patients without recent head or neck trauma, mean age 62.1 years, 63.1% female, 65.57% White, 15.86% Black, and 12.18% Hispanic.
Those with a history of major head or neck trauma were excluded because that might lead to traumatic carotid dissection, while the study’s focus was on spontaneous dissection, which experts believe is secondary to some underlying vascular condition or genetic predisposition, said Shu.
“Most people will experience some minor trauma to their head and neck, but not everyone gets cervical artery dissection; what we’re excluding are those major head and neck traumas with surface injuries or trauma.”
Researchers separated patients into four diagnostic groups: Acute ischemic stroke (AIS; 51.18%), CeAD (0.35%), concurrent AIS and CeAD (0.39%), and the reference group of transient global amnesia or migraine (41.08%). These reference neurological conditions are transient and not typically treated as cerebrovascular disease, commented Shu.
No Elevated Risk
Of the total sample, 16,469 (2.32%) had MI within 1 year. Compared to the reference group, patients with AIS alone had higher MI risk, as did patients with concurrent CeAD and AIS, but patients with CeAD alone had no elevated risk.
After adjustments for common cardiac risk factors such as age, diabetes, heart failure, coronary artery disease, and hyperlipidemia, patients with AIS alone still had the highest risk for MI (adjusted hazard ratio [aHR], 2.20; 95% CI, 1.92-2.52; P P = .005).
Patients with CeAD had nonsignificant risk (aHR, 1.24; 95% CI, 0.87-1.78; P = .235) for 1-year MI.
Based on prior literature, a stroke occurring in the insula area of the brain can directly affect the heart, but in general, it’s more likely that risk factors are causing both the stroke and the subsequent MI, noted Shu.
It’s possible certain underlying factors were not accounted for in the study, although “we thoroughly adjusted for numerous risk factors, and we still saw the relationship,” he said.
For patients with both stroke and CeAD, Shu stressed the importance of not only treating the dissection but also “proactively managing” underlying cerebrovascular and cardiovascular risk factors. “These patients have a heightened risk of MI, regardless of whether the stroke was caused by the dissection.”
The investigators are pursuing other avenues of research to shed more light on CeAD. They aim to determine, for example, if the incidence of CeAD is increasing over time due to more awareness and increased use of diagnostic imaging, whether tissue plasminogen activator is helpful in patients with stroke-like symptoms, and what risk factors affect subsequent stroke for those with CeAD without concurrent stroke.
These new results may not be generalizable to other geographical areas, they noted. Another potential limitation of the study was that it was a retrospective analysis, so it might not have accounted for all factors influencing MI risk such as medication usage, which was not included in the databases.
Well Executed Study
Commenting on this preliminary work, José Biller, MD, professor and chair, Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, said it’s “well-conceived and executed,” and adds to the current literature, but with limitations acknowledged by the authors.
Biller noted most patients with CeAD are relatively young, between 30 and 50 years with a mean age of about 40 years, which is younger than in the current study.
He added the condition is relatively rare, with an annual incidence of 2.6-3.0 per 100,000 but with a favorable prognosis for spontaneous internal carotid artery dissection; 75% make a good recovery.
He would like to know from the current study what percentage of patients with CeAD or concurrent CeAD and AIS had fibromuscular dysplasia.
Shu reported no relevant conflicts of interest.
Source link : https://www.medscape.com/viewarticle/mi-risk-higher-after-stroke-not-cervical-dissection-2024a10002ll?src=rss
Author :
Publish date : 2024-02-06 15:29:04
Copyright for syndicated content belongs to the linked Source.