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Large MRI cohort study: CAHHM

A simple cardiac risk score can predict who may have carotid artery plaque and ‘silent’ strokes which often come before a serious clinical stroke.

The findings come from one of the largest magnetic resonance imaging (MRI) cohort studies in North America, a study designed to understand the risk factors associated with cerebrovascular disease before a person is aware of it.

The study was done by the Canadian Alliance for Healthy Hearts and Minds (CAHHM), led by PHRI senior scientist, Sonia Anand, with Matthias Friedrich at McGill University, and the late Jack Tu from the University of Toronto. A total of 32 investigators from 22 institutions in Canada were involved in the study.

The research was published Sept. 30, 2019 in European Heart Journal – Cardiovascular Imaging.

For this paper, the research involved 7,549 adults with a mean age of 58 years, over half of whom (55%) are women, from across Canada.

“These results are important as they demonstrate that subclinical cerebrovascular disease of the carotid arteries and silent stroke in the brain are more frequent in men and women with a greater burden of cardiovascular risk factors,” said Sonia Anand. “This implies that screening and treatment of cardiovascular risk factors can prevent cerebrovascular disease from developing.”

Cohorts that participated in this study included five regional Canadian Partnership for Tomorrow Project cohorts – British Columbia Generations Project, Alberta’s Tomorrow Project, Ontario Health Study, CARTaGENE and Atlantic PATH – as well as the Prospective Urban Rural Evaluation (PURE) study’s Canadian cohort, and Montreal Heart Institute Biobank.

The analysis shows that for those participants who do not have a history of heart disease or stroke that a simple cardiac risk score – a summary measure of factors such as blood pressure, diabetes, smoking, abdominal fat, and dietary factors – is associated with MRI-detected subclinical cerebrovascular disease like carotid artery plaque and silent strokes. These cardiovascular risk factors are associated with early disease of the arteries that is present before clinical disease such as stroke and suggests that early detection and treatment of these common risk factors is important in disease prevention.

The study was supported by the Canadian Partnership Against Cancer, the Heart and Stroke Foundation, and the Canadian Institutes of Health Research (CIHR).

“This new study validates Heart & Stroke’s ongoing efforts on the heart-brain connection; it reinforces the findings of our ground-breaking 2019 report, ‘(Dis)connected: Unseen links are putting us at risk, which systematically mapped the connections between heart health and brain health,'” said Anne Simard, Heart and Stroke Foundation’s Chief Mission and Research Officer.

“The evidence that vascular diseases are deeply linked continues to grow, and that means a bigger and more frightening problem for most people in Canada, as 90% are at risk of cardiovascular disease,” Simard said.