The following is a summary of “Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis,” published in the March 2024 issue of Neurology by Zhou et al.

Researchers retrospectively examined silent brain infarction (SBI)/ cerebral small vessel disease (CSVD) prevalence in adults with various heart conditions (atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), etc.), comparing stroke history and associations between heart disease and SBI/CSVD.

They conducted systematic searches on Medline, Embase, and Cochrane Library for studies conducted in hospitals or communities that reported SBI/CSVD in individuals with heart disease. Eligible studies were extracted, and outcomes were analyzed, including SBI (primary) and individual CSVD subtypes. Summary prevalence with 95% CIs was determined using random-effects meta-analysis. Pooled PRs with 95% CI were calculated to compare individuals with heart disease to control participants without heart disease from included studies.

The results showed 221 observational studies were included. In individuals with AF, SBI had a prevalence of 36% (31%–41%), lacune 25% (19%–31%), WMH 62% (49%–74%), and microbleed 27% (24%–30%). When stratified by recent stroke, there were no differences in SBI prevalence (phomogeneity = 0.495). Prevalence was similar across different heart diseases except for PFO, where SBI was lower at 21% (13%–30%). Meta-regressions revealed associations between older age and hypertension with more SBIs and WMH. Microbleed prevalence did not differ between those with and without heart disease (PR [95% CI] 1.1 [0.7–1.7]), but differences were observed in SBI and WMH prevalence (PR [95% CI] 2.3 [1.6–3.1] and 1.7 [1.1–2.6], respectively).

Investigators concluded a high prevalence of SBI and CSVD in people with heart disease, regardless of recent stroke, but further studies are needed to explore causality and treatment implications.

Source: neurology.org/doi/10.1212/WNL.0000000000209204