Editors' Note: First-Ever Ischemic Stroke and Increased Risk of Incident Heart Disease in Older Adults

Abstract

Using a propensity-matched cohort of >20,000 patients with acute ischemic stroke and >70,000 matched nonstroke individuals, Dr. Sposato et al. observed a 4-fold higher odds of major cardiac adverse events among patients with recent acute stroke. Importantly, patients were matched based on vascular risk factors, socioeconomic status, hospitalization frequency, and previous medications. The higher incidence of poststroke heart disease may have been related to the index cerebrovascular event, as the authors state. Alternatively, some patients may have experienced a stroke-induced myocardial stunning from excess sympathetic tone, which is supported by existing animal models and observational studies. Dr. Sioka et al. highlighted their own observations (using myocardial perfusion imaging) that subclinical coronary artery disease after stroke may be more common than expected. As noted by Dr. Sposato et al., the cohort reported by Sioka may have been selected for patients at risk of more coronary artery disease, given the stroke mechanisms and vascular profile of the included patients. Whatever the mechanism of myocardial injury, clinicians ought to monitor closely for concomitant cardiac disease among patients with recent cerebral infarction. Using a propensity-matched cohort of >20,000 patients with acute ischemic stroke and >70,000 matched nonstroke individuals, Dr. Sposato et al. observed a 4-fold higher odds of major cardiac adverse events among patients with recent acute stroke. Importantly, patients were matched based on vascular risk factors, socioeconomic status, hospitalization frequency, and previous medications. The higher incidence of poststroke heart disease may have been related to the index cerebrovascular event, as the authors state. Alternatively, some patients may have experienced a stroke-induced myocardial stunning from excess sympathetic tone, which is supported by existing animal models and observational studies. Dr. Sioka et al. highlighted their own observations (using myocardial perfusion imaging) that subclinical coronary artery disease after stroke may be more common than expected. As noted by Dr. Sposato et al., the cohort reported by Sioka may have been selected for patients at risk of more coronary artery disease, given the stroke mechanisms and vascular profile of the included patients. Whatever the mechanism of myocardial injury, clinicians ought to monitor closely for concomitant cardiac disease among patients with recent cerebral infarction.