# Cardiovascular risk factor control in patients with covert brain infarcts in the prospective SILENT cohort study

## TL;DR

The study finds that patients with hidden brain infarcts often have poorly managed cardiovascular risk factors, emphasizing the need for targeted clinical assessments.

## Contribution

This study is the first to prospectively evaluate the control of modifiable cardiovascular risk factors in patients with covert brain infarcts.

## Key findings

- Most patients with covert brain infarcts had at least one poorly controlled cardiovascular risk factor.
- The number of cardiovascular risk factors was significantly associated with the number of brain infarcts.
- Therapeutic interventions were initiated in over half of the patients following risk factor assessment.

## Abstract

Covert brain infarctions (CBIs) are associated with cardiovascular risk factors (cvRFs). We aimed to evaluate the presence and therapeutic implications of modifiable cvRFs in patients with incidentally discovered CBI on routine neuroimaging.

The SILENT cohort (NCT05685069) is a prospective, multicentred European cohort recruiting patients with incidentally detected focal CBIs on routine MRI, without prior clinical stroke. Modifiable cvRFs and their control were assessed using applicable international guidelines during a dedicated outpatient visit, including a clinical examination and laboratory work-up. Associations between cvRF profiles and the number of CBIs were analysed using linear regression.

We included 231 patients (mean age 65 years, n = 130 [56%] male) with a total of 445 CBI lesions. Most CBIs were of lacunar type (n = 226; 51%) and the most common location was the cerebellum (n = 220; 50%). One hundred and fifty (65%) patients had at least 1, 112 (49%) at least 2 and 56 (24%) at least 3 known modifiable cvRFs. Among hypertensive patients, 69 (53%) had uncontrolled hypertension; 22 (65%) of diabetics were insufficiently controlled and 74 (58%) patients with dyslipidaemia had poorly controlled low-density lipoprotein cholesterol. Therapeutic measures were made for 144 patients (62%), including antiplatelet initiation in 107 (46%) and a statin in 69 (30%). The number of cvRFs per patient was significantly associated with the number of CBIs, rate ratio 1.08 (95% Confidence Interval (CI), 1.04−1.13).

In patients with incidentally discovered CBI, we found a high burden of poorly controlled cvRFs. Our findings highlight the importance and yield of a dedicated clinical and laboratory assessment of cvRFs in patients with CBIs.

Graphical Abstract