From Our 2011 Archives
'Mini-Strokes' May Increase Risk of Heart Attack
Study Shows Transient Ischemic Attacks Are Linked to Greater Risk of Heart Attack
By Denise Mann
Reviewed by Laura J. Martin, MD
The findings appear in the journal Stroke.
A TIA occurs when blood flow to an area of the brain is temporarily disrupted. TIA symptoms include: numbness or weakness in the face, arm or leg; confusion; double vision or loss of vision; dizziness; and trouble walking or talking. The symptoms come on suddenly and typically resolve within one to two hours without causing any permanent neurologic damage.
In the new study, people who experienced a TIA had about a 1% risk of heart attack per year, which is double that of people in the general population. The increased risk persisted for years, and was most pronounced among people younger than 60. The average time between TIA and heart attack was five years, the study shows.
TIA and Heart Risk
"Patients who have had a TIA but do not have known [coronary artery disease] have approximately twice the risk for subsequent [heart attack], compared to the general population," conclude study researchers who were led by Robert D. Brown, Jr., MD, MPH, chair of the neurology department at the Mayo Clinic in Rochester, Minn. "These data support the existing concept that careful attention to the primary prevention of [heart disease] is warranted in all patients who have TIA [and] that screening for asymptomatic [heart disease] may be useful in select TIA patients."
Close to two-thirds of the people who experienced a TIA had high blood pressure; more than 50% were smokers and three-quarters were being treated with medication to reduce their risk for developing blood clots, the study shows. High blood pressure and smoking are major risk factors for heart attack.
People who were taking statins to lower their cholesterol were also at greater risk for heart attack after a TIA, the new report showed.
TIAs Are Warning Signs
Stephen Green, MD, associate director of the Cardiac Catheterization Laboratories at North Shore University Hospital in Manhasset, N.Y., says that TIAs should be viewed as red flags for heart attacks and strokes.
"If you have had a TIA, treat it as a warning sign, and make sure that you see your doctor to make sure you are doing everything you can to minimize your chance for having a heart attack," he says.
"You need to see a neurologist and a primary care doctor or cardiologist who is going to look at your brain and heart to make sure that your diabetes and/or cholesterol is controlled, you are not smoking and doing all the right things," he says.
Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City, agrees that TIAs need to be taken seriously.
"The term 'mini stroke' trivializes these events," he says. "We need to take a look at blood vessels to the brain and heart because this symptom means you have a strong possibility of having vascular disease and the next symptom could be in your heart."
Sophia Sundararajan, MD, PhD, a neurologist at University Hospitals Case Medical Center in Cleveland, says that people often don't take TIAs seriously because they get better and don't have any lasting problems.
But that is a mistake, she says. "It is a warning sign for stroke and also a warning sign for heart attack." If you experience or think you may have experienced a TIA, seek evaluation ASAP, she says.
SOURCES: Sophia Sundararajan, MD, PhD, neurologist, University Hospitals Case Medical Center, Cleveland.Stephen Green, associate director, Cardiac Catheterization Laboratories, North Shore University Hospital, Manhasset, N.Y.Roger Bonomo, MD, director, stroke care, Lenox Hill Hospital, New York City.Burns, J.D. Stroke, 2011.