Why Monitoring Your Heart Health Matters After Surviving a Stroke

New research shows how common—and dangerous—it is to develop heart complications following a stroke.

heart connected to brain with a stethoscope on EKG background
Photo: Alex Sandoval

People who survive an ischemic stroke are at an increased risk of developing major heart issues in the month following—which then puts them at greater risk of death, heart attack, or a second stroke within the next five years, new research shows.

The new study, published in the American Heart Association's journal Stroke, found that people who develop stroke-heart syndrome—or cardiovascular complications following a stroke—can suffer long-term health consequences. The recent findings present strong evidence of the close relationship between the heart and the brain, and suggest where improvements in care are needed.

"I was particularly surprised by how common stroke-heart syndrome was and the high rate of recurrent stroke in all subgroups of adults with stroke-heart syndrome," lead study author Benjamin J.R. Buckley, PhD, a postdoctoral research fellow in preventive cardiology at the Liverpool Centre for Cardiovascular Science at the University of Liverpool, said in a press release. "This means that this is a high-risk population where we should focus more secondary prevention efforts."

Heart Complications After Stroke

Stroke-heart syndrome is a condition where people develop heart complications after an ischemic stroke, the most common type of stroke, making up 87% of all stroke cases. An ischemic stroke occurs when blood flow is blocked from entering the brain.

The heart problems associated with stroke-heart syndrome include: acute coronary syndrome, angina (chest pain), heart rhythm issues (atrial fibrillation, arrhythmia, ventricular fibrillation), heart attack, heart failure, and Takotsubo syndrome (broken heart syndrome). Though it was previously known that stroke-heart syndrome could lead to short-term consequences, the new research is "the largest evidence-based [study] regarding the prevalence and long-term clinical outcomes" of the condition, Dr. Buckley told Health.

For the new study, Buckley and a team of researchers studied the medical records of 365,383 adults from 53 different hospitals, mainly in the U.S., who recovered from an ischemic stroke between 2002 and 2021. People who were diagnosed with stroke-heart complications were compared to a similar number of people who did not develop heart complications in the four weeks following the stroke.

Of all stroke survivors in the study, about 11% developed acute coronary syndrome. Another 8.8% had atrial fibrillation, 6.4% had heart failure, 1.2% had severe ventricular arrhythmias, and 0.1% had a diagnosis for Takotsubo cardiomyopathy

The risk of both death and being hospitalized again significantly increased among patients with the newly developed heart complications following ischemic stroke. Those who developed heart failure had an 83% higher risk of dying in the five years following their stroke, while acute coronary syndrome and atrial fibrillation increased the risk of death by 49% and 45%, respectively. The risk of death more than doubled when a person developed severe ventricular arrhythmias.

Strokes were more likely to occur again too: People who developed atrial fibrillation were 10% more likely to have a second stroke. Overall, all patients who had a stroke and heart issues were 50% more likely for another stroke in the next five years.

The chances of a second ischemic stroke were 10% higher among those who developed atrial fibrillation after the stroke. "This is therefore a high-risk population where we should focus more secondary preventive efforts," Dr. Buckley said.

While the findings build on the premise that the heart and brain work hand in hand, it is still unknown whether later heart problems were caused by the first stroke or contributed to the stroke.

According to Rigved V. Tadwalkar, MD, a cardiologist at Providence Saint John's Health Center who was not involved in the study, it all depends on if a person already has cardiovascular risk factors when they have their stroke. "They're very closely linked," he told Health. "Cardiovascular risk factors include things we can't control like age and genetics, and there are others that may be under our control if they're identified early like blood pressure and tobacco use."

Secondary Stroke Prevention Plans

According to the American Stroke Association, every stroke survivor should receive a personalized secondary stroke prevention plan, which can include information on how to manage high blood pressure, control cholesterol, and quit smoking, among other things.

Part of that secondary stroke prevention plan, according to Dr. Buckley, is for patients to seek follow-up care from both neurologists and cardiologists after a stroke.

"I do think this data highlights the importance of neurologists and cardiologists working together, not independently, as part of a personalized secondary stroke prevention plan," he said. "This may be particularly important for people with stroke-heart syndrome,"

The aftercare from both types of specialists is something that hasn't always happened previously. "There's been an increasingly collaborative effort among neurologists and cardiologists as the years go on, and we're learning more about how our fields overlap significantly," Dr. Tadwalkar said. "That close synergy between neurologists and cardiologists is essential in the care of today's stroke patients, which differs very much from what we had seen in the past."

For those who develop stroke-heart syndrome, Dr Tadwalkar said there are both medical and nonmedical treatment options available, including physical therapy, or dietary changes like reducing alcohol intake or avoiding foods with high sugar or saturated fat content.

Your doctor may also prescribe blood thinners or certain cholesterol-lowering agents to control your blood pressure. Dr. Tadwalkar said some people may undergo minimally invasive heart surgery to reduce their risk of further complications, "but how these treatments are chosen depends on the mechanism of the stroke, how we think it occurred, and what other cardiovascular issues have been identified," he said.

While the new research provides more information on the "fascinating two-way link between the brain and the heart," according to Dr. Buckley, more research is needed to explore how doctors can better predict stroke-heart syndrome—and ultimately, prevent it.

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