Stripped-down CV risk score offers insight into cerebrovascular health

A simplified cardiac risk score can identify plaque buildup and silent brain infarctions that could predict a serious stroke, acting as a red flag for patients without a history of CVD or other vascular problems.

Writing in the European Heart Journal: Cardiovascular Imaging Sept. 30, Sonia Anand, co-principal investigator for the Canadian Alliance for Healthy Hearts and Minds Cohort Study, and colleagues said the aim of their study was to achieve what few others had: establishing a connection between bare-bones cardiac risk scores and MRI-detected subclinical cerebrovascular disease, including carotid wall volume (CWV), carotid intraplaque hemorrhage (IPH) and silent brain infarction (SBI). 

“Most prior MRI cohort studies have been conducted in older populations, in which participants were selected for MRI based on increased subclinical carotid disease on ultrasound, and few large population-based studies have evaluated whether simple cardiac risk scores are associated with MRI-detected subclinical cerebrovascular disease,” the authors wrote.

Anand and her team recruited 7,549 CVD-free adults from across Canada for their study, all of whom underwent risk factor assessment and a non-contrast-enhanced MRI of the carotid arteries and brain. The researchers calculated the non-lab-based INTERHEART risk score (IHRS) for all participants and the Framingham Risk Score in a subset of 3,889 subjects who provided blood samples.

The authors found that each five-point increase in the IHRS was linked to a 9 mm-cubed increase in CWV, a 23% increase in IPH and a 32% increase in SBI. The relationships were consistent for lacunar and non-lacunar brain infarction, and the Framingham Risk Score was also significantly associated with CWV, IPH and SBI in applicable patients.

“Assessment of subclinical vascular injury is a useful adjunct to identify individuals who require risk factor control to prevent the development of clinical events,” Anand et al. wrote. “Our findings add significantly to the body of literature which shows that subclinical vascular disease begins far earlier in life than at the time of clinical presentation of first MI, stroke or death, and that pre-clinical measures of carotid atherosclerosis predict the development of severe cerebrovascular injury.”

The authors said their study is an example that a simple cardiac risk score like IHRS—a summary measure of variables like blood pressure, diabetes, smoking, abdominal fat and diet—could be hugely beneficial to patients without a history of heart disease.

“This implies that screening and treatment of cardiovascular risk factors can prevent cerebrovascular disease from developing,” Anand said in a statement.