Author Response: First-Ever Ischemic Stroke and Increased Risk of Incident Heart Disease in Older Adults

We thank Dr. Sioka et al. for their positive comments about our article1 showing a high risk of major adverse cardiovascular events after acute ischemic stroke. They also summarized the results of their study on myocardial perfusion tests among patients with a recent (<30 days) ischemic stroke.2 Dr. Sioka et al. found changes suggestive of myocardial ischemia in 62% of the cases.2 Notably, this was a wittingly selected population of patients with atherosclerotic strokes and a high prevalence of smokers (63%) and hyperlipidemia (58%). Thus, the high prevalence of asymptomatic coronary artery disease (CAD) in this study is somehow expected. Indeed, consistent with their interpretation, asymptomatic CAD is the most likely explanation for the impaired myocardial perfusion tests. However, in less selected populations, cardiovascular complications may not be due to asymptomatic CAD, since the reported prevalence of severe coronary artery atherosclerosis in patients with acute ischemic stroke and no history of CAD undergoing systematic coronary angiography is only 16%.3 Interestingly, the meaning of impaired myocardial perfusion scanning in stroke patients is not well understood. Takotsubo myocardiopathy can occur after stroke and is associated with transiently impaired myocardial perfusion tests in the absence of atherosclerotic CAD.4

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