Image of Alexander E. Merkler, M.D.

Older adults who have a symptomless heart attack have the same risk of stroke as their peers who experience a chest-crushing event, according to a new study to be presented at the upcoming American Stroke Association International Stroke Conference 2021.

These silent heart attacks also are more common in older adults than classic heart attacks with symptoms, investigators found. This suggests these silent events should be considered a new risk factor for stroke among adults 65 and older, said study author Alexander E. Merkler, M.D., a neurologist at Weill Cornell Medicine in New York City. 

The researchers analyzed health information from more than 4,200 adult participants in the Cardiovascular Health Study. Their stroke risk was tracked annually for 10 years. 

They found that:

  • Participants who had evidence of a silent heart attack had a 47% increased risk of developing a stroke, compared with those who did not have a silent heart attack;
  • Participants with classic heart attack symptoms were 80-fold more likely to experience a stroke within one month after the event, compared with participants who were heart attack-free; and
  • After one month, participants with classic heart attack symptoms had a 60% increased risk of having a stroke.

“Our research suggests the increased risk for having a stroke in those with silent heart attacks is similar to the risk found in traditional heart attacks. A silent heart attack may be capable of causing clots in the heart that dislodge and travel to the brain causing a stroke,” said Merkler, who specializes in stroke and acute brain and spine injury.

Although more needs to be done to determine the best treatments for silent heart attack survivors, the results indicate that seniors with evidence of a silent heart attack found on an electrocardiogram should be considered to have an increased risk of stroke, the researchers concluded.

The ASA conference will run virtually March 17-19.