Even very small brain lesions increase risk for death; Coronary artery calcification scans could help to identify patients at risk for premature death

1. For patients with no history of stroke, even very small brain lesions increase risk for death

For asymptomatic patients with no history of clinical stroke, having even very small brain lesions (less than 3 mm) detected by magnetic resonance imaging (MRI) triples their risk for stroke and death, according to a study published in Annals of Internal Medicine. Having both very small and larger lesions increases the risk to eight-fold.

Subclinical brain infarctions are typically defined as lesions 3 mm or larger on imaging in patients without a history of stroke. These lesions have been associated with an increased stroke and death, particularly in older patients. The clinical significance of smaller lesions has not been explored.

Researchers examined MRI data for a large cohort of patients from two Atherosclerosis Risk in Communities (ARIC) Study sites to determine the association between lesion size and incident stroke, stroke-related mortality, and all-cause mortality. They found that having very small lesions only or having lesions 3 mm or larger only was associated with increased risk for stroke and death in middle-aged and older patients. Having both types of lesions at the same time was associated with a particularly striking risk increase. The authors conclude that clinicians may want to reconsider the practice of dismissing very small cerebral lesions found on MRI.

2. Coronary artery calcification scans could help to identify patients at risk for premature death

Physicians can use coronary artery calcification (CAC) scores to accurately predict 15-year mortality in asymptomatic patients, according to a study published in Annals of Internal Medicine. Previous reports on the prognostic value of CAC scores have had a limited duration of follow-up.

CAC scores have been used to estimate cardiovascular prognosis and all-cause mortality in the short term. Researchers collected CAC scores and binary risk factor data for a large cohort of asymptomatic patients at a single-center, outpatient cardiology laboratory to determine the ability of CAC scores to predict long-term mortality. They found that the score accurately predicted all-cause mortality up to 15 years in asymptomatic patients. The authors suggest that CAC scanning could help to identify patients at risk for premature death. Patients with high scores could be advised to adopt healthier lifestyles, which could lead to better outcomes.