Features June 2011 Issue

“Mini-Strokes” Can Double Your Heart Attack Risk

Study shows that transient ischemic attacks not only raise your risk of stroke, but put you in jeopardy of other cardiac events.

You know that a "mini stroke" is the warning sign that a larger stroke is imminent. Now a new study finds that mini strokes, which are formally known as transient ischemic attacks (TIAs), are also precursors to heart attacks.

The study, published in the March issue of†Stroke: The Journal of the American Heart Association,†found that a TIA actually doubles a patientís risk of heart attack.

"TIAs and heart attacks are linked by inflammation, so it makes perfect sense to me," says J. Javier Provencio, MD, a neuro intensivist and associate director of the Bakken Heart Brain Institute at Cleveland Clinic.

A TIA happens when a blood clot stops blood flow to the brain temporarily. It causes similar symptoms as a full-blown stroke but it does not result in the same long-term disability. It does, however, put you at an extremely high risk for a full-blown stroke.

Research Shows

The study looked at 456 patients who suffered TIAs. Researchers found that the risk of having a heart attack was one percent per year. The average time between a TIA and a heart attack was five years. Thatís double the risk of people who have not had TIAs. The risk also increases with certain factors. For example, men who are younger than age 60 are 15 times more likely to suffer a heart attack after a mini stroke. But Dr. Provencio says the TIA is not the culprit. Itís just the messenger.

"TIAs donít cause heart attacks," explains Dr. Provencio. "Inflam­mation in brain blood vessels cause TIAs and inflammation in heart blood vessels cause heart attacks, so if you have high inflammation in both, youíre likely to have both."

Dr. Provenico and his team focus on trying to determine the cause of a TIA.

"In some cases it may be atherosclerotic plaque and when it ruptures it cases the TIA, and in other cases it may be an embolism in the heart."

Diagnosing a TIA

The investigation to find the TIA cause typically includes hooking up the patient to a heart monitor for several hours, conducting an EKG and an echocardiogram to look for atrial fibrillation and signs of atherosclerosis.

"We also do an ultrasound in the carotid artery for plaque and an MRI of the brain to see if thereís plaque in the blood vessels," says Dr. Provencio.

His team doesnít screen for coronary artery disease, however. He says if he has suspicions heíll recommend that patients speak with their family physicians about the next step. Dr. Provencio says patients should mention the results of the new study to get their doctorís take on how it affects them.

He would caution against TIA patients undergoing serious procedures to hunt for heart disease just because of the confirmed link between TIAs and heart attack.

"If you do stress testing it makes sense, but if you do a cardiac catheter procedure on every stroke patient, thatís worrisome. Itís dangerous."

Preventive Measures

Beyond screenings, TIA patients may want to consider taking other steps to prevent a heart attack. That includes exercising, eating a healthy diet, taking aspirin and getting cholesterol under control. Talk to your doctor about your risk factors and what you should do about them.

In addition, know the symptoms for both TIA and heart attack.

The symptoms for a mini stroke include an extremely painful headache and numbness on one side of the body in the face, arm or leg, as well as difficulty seeing, trouble walking and difficulty speaking or understanding others.

The symptoms of a heart attack include discomfort in the center of the chest that lasts more than a few minutes; discomfort in the arms, back, neck or jaw; shortness of breath; nausea and lightheadedness.

Most important is getting to the hospital immediately if you have these symptoms, reminds Dr. Provencio.