title: Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Silent brain infarction (SBI) on magnetic resonance imaging has been proposed as a subclinical risk marker for future symptomatic stroke. We performed a systematic review and meta-analysis to summarize the association between magnetic resonance imaging-defined SBI and future stroke risk.
  
  
  METHODS
  We searched the medical literature to identify cohort studies involving adults with SBI detected by magnetic resonance imaging who were subsequently followed up for incident clinically defined stroke. Study data and quality assessment were recorded in duplicate with disagreements in data extraction resolved by a third reader. Strength association between magnetic resonance imaging-detected SBI and future symptomatic stroke was measured by an hazard ratio.
  
  
  RESULTS
  The meta-analysis included 13 studies (14 764 subjects) with a mean follow-up ranging from 25.7 to 174 months. SBI predicted the occurrence of stroke with a random effects crude relative risk of 2.94 (95% confidence interval, 2.24-3.86, P<0.001; Q=39.65, P<0.001). In the 8 studies of 10 427 subjects providing hazard ratio adjusted for cardiovascular risk factors, SBI was an independent predictor of incident stroke (hazard ratio, 2.08 [95% confidence interval, 1.69-2.56; P<0.001]; Q=8.99; P=0.25). In a subgroup analysis pooling 9483 stroke-free individuals from large population-based studies, SBI was present in ≈18% of participants and remained a strong predictor of future stroke (hazard ratio, 2.06 [95% confidence interval, 1.64-2.59]; P<0.01).
  
  
  CONCLUSIONS
  SBI is present in ≈1 in 5 stroke-free older adults and is associated with a 2-fold increased risk of future stroke. Future studies of in-depth stroke risk evaluations and intensive prevention measures are warranted in patients with clinically unrecognized radiologically evident brain infarctions.
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.). ajg9004@med.cornell.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Giambrone
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Gino
authors.initials: G
authors.lastname: Gialdini
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Caitlin
authors.initials: C
authors.lastname: Finn
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Diana
authors.initials: D
authors.lastname: Delgado
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Jose
authors.initials: J
authors.lastname: Gutierrez
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Clinton
authors.initials: C
authors.lastname: Wright
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Alexa S
authors.initials: AS
authors.lastname: Beiser
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Sudha
authors.initials: S
authors.lastname: Seshadri
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Ankur
authors.initials: A
authors.lastname: Pandya
authors.affiliation: From the Department of Radiology (A.G., C.F.), Feil Family Brain and Mind Research Institute (A.G., G.G., H.K.), Department of Healthcare Policy and Research (A.E.G.), Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY (J.G.); Department of Neurology, University of Miami Miller School of Medicine, FL (C.W.); Department of Biostatistics, Boston University School of Public Health, MA (A.S.B.); Department of Neurology, Boston University School of Medicine, MA (S.S.); and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.).
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
mesh_terms: D020520:Brain Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D005544:Forecasting; D006801:Humans; D064887:Observational Studies as Topic / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*
keywords: brain infarction; infarction; magnetic resonance imaging; risk factors; stroke