People who survive an ischemic stroke are much more likely to develop serious heart complications in the first month after their stroke and therefore have an increased risk of dying, having a heart attack, or another stroke within five years compared to people who are not short develop heart problems after a stroke, according to new research published today in Stroke, the flagship peer-reviewed journal of the American Stroke Association, a division of the American Heart Association.
Ischemic stroke is the most common form of stroke – accounting for 87% of all strokes – and occurs when blood flow to the brain is blocked. Cardiovascular complications, the so-called stroke heart syndrome, often occur after a stroke. Cardiac complications include acute coronary syndrome, angina (chest pain), cardiac arrhythmias such as atrial fibrillation, arrhythmia, and ventricular fibrillation; Heart attack; Heart failure or Takotsubo syndrome (broken heart syndrome), a type of stress-related temporary enlargement of part of the heart that affects its ability to pump effectively. These disorders increase the risk of disability or death in the short term, but the long-term consequences for people with stroke and heart syndrome are unknown.
“We know that heart disease and stroke have similar risk factors, and there is a mutual relationship between the risk of stroke and heart disease heart disease,” said Benjamin JR Buckley, Ph.D., lead author of the study and postdoctoral fellow in preventive cardiology at the Liverpool Center for Cardiovascular Science, University of Liverpool in the UK “We wanted to know how common are newly diagnosed cardiac complications after stroke and, importantly, whether stroke cardiac syndrome is associated with an increased risk of serious long-term adverse events.”
Researchers analyzed the medical records of more than 365,000 adults treated for ischemic stroke between 2002 and 2021 at more than 50 health care facilities mostly in the United States. Individuals diagnosed with heart attack complications within four weeks of a stroke were matched to an equal number of stroke survivors who did not have these heart complications within four weeks (the control group).
After adjusting for potential confounders such as age, gender, and race/ethnicity, and comparing stroke survivors who had new heart complications to those who didn’t, the analysis found:
- Overall, among all stroke survivors in the study, approximately 1 in 10 (11.1%) developed an acute coronary syndrome, 8.8% were diagnosed with atrial fibrillation, 6.4% developed heart failure, and 1.2% had major ventricular arrhythmias and 0.1% developed ‘broken heart’ syndrome within four weeks of the stroke.
- Risk of dying within five years after a stroke was significantly increased in participants with new cardiac complications: 49% more likely if they had developed acute coronary syndrome; 45% more likely if they had developed atrial fibrillation/flutter; and 83% more likely if they develop heart failure. Severe ventricular arrhythmias doubled the risk of death.
- The risk of hospitalization and a heart attack within five years of a stroke was also significantly higher among those who developed heart complications within the one-month window.
- Stroke survivors with Takotsubo syndrome were 89% more likely to have a major cardiac event within five years of their stroke.
- People who developed AF after a stroke were 10% more likely to have a second stroke within five years of their stroke.
- People with stroke and newly diagnosed cardiovascular complications were 50% more likely to have another stroke within five years of the first stroke.
“I was particularly surprised at how common stroke heart syndrome was and the rate of stroke in all subgroups of adults with stroke heart syndrome,” Buckley said. “This means that this is a high-risk population that we should focus more on for secondary prevention.”
The study’s findings build on the understanding of the mutual connection between the brain and heart and extend that understanding to long-term health outcomes. “We are working on further research to determine how stroke syndrome can be better predicted,” Buckley said.
“We also need to develop and implement treatments to improve outcomes for people with stroke heart syndrome,” Buckley said. “For example, extensive exercise-based rehabilitation can be helpful after a stroke, so it should also be beneficial, maybe even more so, for people who have had a stroke and new heart complications. I think this is an interesting area for future research.”
The study’s limitations include that it is a retrospective analysis and it is unclear whether the cardiac complications diagnosed after ischemic stroke were caused by stroke or more likely contributed to the stroke.
“This research underscores why it is so important for neurologists and cardiologists to work hand-in-hand with their patients and with each other to understand why the first stroke occurred and conduct a comprehensive assessment to identify new risk factors for another stroke and for cardiovascular disease may necessitate the initiation of preventive therapies,” said Lee H. Schwamm, MD, honorary chair of the American Stroke Association Advisory Committee and C. Miller Fisher Chair in Vascular Neurology at Massachusetts General Hospital in Boston “The American Stroke Association recommends every stroke survivor have a personalized secondary stroke prevention plan.”
Co-authors are Stephanie L. Harrison, Ph.D.; Andrew Hill, MBCh.B.; Paula Underhill; Deirdre A. Lane, Ph.D.; and Gregory YH Lip, MD
Materials provided by American Heart Association. Note: Content can be edited for style and length.