Reducing Rates and Risk of Stroke in Adults With Congenital Heart Disease: What Can We Do Now, and What Should We Do Next?

ongenital heart disease (CHD) is the most common birth defect, affecting approximately 1% of all live births. 1 Importantly, due to medical and surgical advances over the past several decades, it is also now the fastest-growing area of adult cardiology.Even for complex congenital heart lesions, which comprise approximately 10% of CHD, survival well into adulthood is now commonplace, and adults with CHD now outnumber children living with CHD. 2 See Article by Sodhi-Berry et al.A longer lifespan with CHD, however, is also associated with a longer exposure to health risks, both later-stage CHD-related complications as well as general aging-related conditions, 3 and potentially in synergy.4 In particular, strategies to optimize brain health in this population remain a priority for further research.People with CHD may experience baseline susceptibilities to their brain health from neurodevelopmental and acquired insults beginning in early life 5 and may be at increased risk for dementia, particularly earlieronset disease.6 For individuals with CHD, who have an overall increased risk for stroke, it is therefore critical to have a better understanding as to which individuals with CHD are at highest risk, when in their lives they are most susceptible, and why.Neurocognitive trajectories in people with CHD in particular may be affected by stroke, which in the general population is the leading cause of adult-acquired disability and a major risk factor for cognitive impairment and dementia.7 In this issue of the Journal of the American Heart Association (JAHA), Sodhi-Berry and colleagues describe incidence and risk factors for ischemic and hemorrhagic stroke in adults with CHD (ACHD) using administrative data from Western Australia from 2000 to 2017.8 The authors calculated estimates for ageand sex-stratified incidence rate ratios for stroke in ACHD versus the general population and assessed ACHD-specific risk factors for stroke using a nested case-control design.The study contributes additional knowledge regarding rates of stroke in ACHD, described in only a handful of population-based studies to date.It also contributes data from Australasia; previous estimates are from North American and Northern European data.[9][10][11] Information capturing Indigeneity status and rurality are additional strengths.Identifying CHD within administrative data can be a challenge in and of itself due to misclassification alongside codes for acquired cardiac disease.12 The authors used methods that were previously validated outside of Australia, but