The risk of a heart attack nearly doubles in the first year after a stroke or when it is combined with a tear in the wall of an artery in the neck, but a tear without a stroke does not appear to increase the risk of a heart attack, according to preliminary research to be presented at the American International Stroke Association Stroke Conference 2024. The meeting will be held in Phoenix, February 7-9, and is the world’s premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
Our findings may help physicians assess and manage cardiovascular risk after these events.”
Liqi Shu, MD, clinical fellow in neurology, Warren Alpert Medical School of Brown University in Providence, Rhode Island
Aortic dissection is a tear in the wall of the aorta, the large artery that receives blood directly from the heart, and is known to increase the risk of heart attack. Tears in the walls of the carotid or vertebral arteries, which extend outside the aorta and carry blood through the neck to the brain, are called carotid or vertebral artery dissections. These dissections can lead to stroke, and stroke is known to be associated with heart attack. It was unclear whether carotid or vertebral artery dissection itself increased the risk of heart attack before this study.
Researchers analyzed health information on more than 800,000 adults (mean age 63, 62% women) who were hospitalized in New York (between 2011 and 2017) or Florida (between 2011-2019). Patients with no history of recent severe head or neck trauma were divided into four groups based on diagnoses: acute ischemic stroke; carotid artery dissection? both; or a reference group of patients with a transient ischemic attack known as a ‘warning stroke’, temporary short-term memory loss (transient global amnesia) or migraine.
After adjusting for heart attack risk factors, the study found:
- Patients who underwent carotid or vertebral artery dissection without stroke had the same risk of having a heart attack within one year as those in the control group.
- Patients with stroke, either with or without carotid or vertebral artery dissection, were almost twice as likely to have a heart attack within one year, compared with patients in the control group.
“Previously, it was just speculation, but now we know that non-stroke carotid or vertebral artery dissection does not increase the risk of heart attack, and it makes sense for clinicians to focus primarily on stroke prevention in this subgroup of patients. Sue said.
Study history:
- Participants with a recent history of severe head or neck trauma were excluded. Head or neck trauma can lead to traumatic carotid dissection, which is different from this study’s focus on spontaneous dissection.
- The analysis controlled for many heart attack risk factors, including age, type 1 or type 2 diabetes, heart failure, coronary heart disease, high cholesterol and high blood pressure.
- Nearly 20,000 of the participants had a heart attack within a year of their initial hospitalization, and the risk of heart attack was compared between diagnostic groups.
- Among the study group of 823,634 participants, 65.4% were white, 16.2% were black or African American, and 12.2% were Hispanic or Latino adults.
While this study is based on hospitalization data only in New York and Florida, it is important to note that these states collectively represent a significant portion of the US population, accounting for over 10% of the total. These two states also provide a good representation of different demographic groups, adding strength to the findings. However, caution should be exercised when generalizing these results to individuals living in other geographic areas. Additionally, this retrospective analysis (looking back in time to analyze data) may not have taken into account all factors that affect heart attack risk, such as medication use, which was not included in the databases.
According to the American Heart Association’s 2024 Update on Heart Disease and Stroke Statistics, stroke accounted for about 1 in 21 deaths in the United States in 2021.
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