Burden of atherosclerosis, cardiovascular risk factors and atrial fibrillation in individuals with covert brain infarcts in late midlife: the Akershus Cardiac Examination 1950 Study.

Covert brain infarcts (CBI) were identified in 13% of participants who underwent MRI examination.

• MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study.
• CBI was identified in 54 participants (13%).
• Mean age at MRI examination was 70.2±2.3 years.
• 165 (41%) of MRI participants were women.
• CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke.

There were no differences in mean carotid plaque score between participants with CBI and those with normal MRI findings.

• Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score.
• No statistically significant difference in carotid plaque burden was found between CBI and non-CBI groups.
• The carotid plaque burden was described as 'age-appropriate' in those with CBI.
• Cardiovascular risk assessment was performed at study inclusion (2012–2015), prior to MRI.

SCORE2 and CHA₂DS₂-VA scores did not differ between participants with CBI and those without CBI.

• No differences in mean SCORE2 score were found between CBI and non-CBI participants.
• No differences in mean CHA₂DS₂-VA score were found between CBI and non-CBI participants.
• SCORE2 (Systematic COronary Risk Evaluation 2) was used to estimate cardiovascular risk.
• CHA₂DS₂-VA score was calculated to estimate stroke/thromboembolic risk.

AF screening via 72-hour ambulatory ECG monitoring in participants with CBI yielded a detection rate of 2%.

• 45 of 54 (83%) participants with CBI completed 72-hour ambulatory ECG monitoring.
• AF was detected in only one (2%) participant with CBI.
• Screening was offered to all participants with CBI following MRI detection.
• This low yield is consistent with current expert consensus recommending AF screening upon CBI detection, but suggests limited incremental benefit in this age group.

The study population was a prospective population-based birth cohort of individuals born in 1950 residing in Akershus County, Norway.

• The study is the Akershus Cardiac Examination (ACE) 1950 Study.
• Participants were residents of Akershus County served by two hospitals.
• MRI was performed in a randomly selected, blood pressure-stratified subset of participants between 2016 and 2024.
• Cardiovascular risk assessment was performed at study inclusion between 2012 and 2015.
• ClinicalTrials.gov identifier: NCT01555411.

Current expert consensus generally suggests cardiovascular risk assessment including AF screening upon detection of CBI, but evidence to guide management remains limited.

• No randomised clinical trials specifically targeting CBI populations were available to guide management.
• The authors aimed to provide observational data comparing CBI and non-CBI individuals to inform management.
• The study was motivated by the gap between consensus recommendations and available evidence.