Study of more than 13,000 participants finds common blood vessel changes in the brain are linked to risk of stroke and dementia, even in people with heart disease who haven’t had a stroke did. This is the best review of hidden brain abnormalities in heart patients, published in Neurology®. Lead author Dr. Zien Zhou, from the George Institute for Global Health, believes identifying these changes could help choose more appropriate treatments for these people.

Lead author Dr Zien Zhou from the George Institute for Global Health said: “People with heart disease are two to three times more likely than the general population to have changes in the brain’s vasculature, but unless they have had a stroke, these patients have They often go undetected because they don’t undergo brain imaging tests.”

Only brain imaging can identify cerebrovascular abnormalities associated with cerebral small vessel disease (CSVD) and silent cerebral infarction (SBI). Older people and people with high blood pressure are more likely to experience it. Even if there are no obvious symptoms, it can induce subtle neurological problems and increase the chance of developing dementia or stroke in the future.

To find out how often these hidden brain changes occur in adults with diseases such as atrial fibrillation, coronary artery disease, and heart failure, researchers at the George Institute studied data from 1988 to 2022. analyzed 221 studies published during the period.

According to research, people with heart disease include:

• One-third of them had a silent cerebral infarction (SBI).
• One quarter showed cavities, small empty areas in the brain left behind by trauma.
• Two-thirds had white matter lesions, a sign of nerve fiber damage.
• Microbleeds in the brain tissue were present in 25% of cases.
• More than half experienced brain atrophy or shrinkage.

These changes were similar whether the person had a recent stroke or not, and there were no differences between men and women. Dr. Zhou pointed out that heart disease is a significant cause of these brain changes, reflecting brain vulnerability.

Dr. Zhou suggested that reduced cardiac output in some heart patients may affect blood flow to the brain, leading to vascular changes and cognitive problems. He also pointed out that hidden brain changes and cognitive problems may be caused by small blood clots traveling from the heart to the brain.

Further research is needed to manage individuals affected by these brain abnormalities and to elucidate their causes. Dr. Zhou suggested investigating whether a second MRI scan is worth it for people considering anticoagulation therapy, which many heart patients require, to reduce side effects.

Understanding the risk of brain blood clots and bleeding from anticoagulants can help choose the best treatment for heart disease patients and may make treatment safer.

This study highlights that many people with heart disease have hidden changes in their brains. This shows how important thorough brain imaging is for them. Knowing why these changes occur and what they mean is essential to finding the best way to safely manage and treat heart disease.

Reference magazines:

1. Zien Zhou, Shoujiang You, et al. Hidden cerebrovascular changes in heart disease patients. Neurology. DOI: 10.1212/WNL.0000000000209204.