AbstractObjectivesThis study aimed to investigate the association between electrocardiogram (ECG) abnormalities and silent vascular brain injury as defined by cerebral magnetic resonance imaging (MRI) in a stroke‐free community‐based population.MethodsA total of 5888 participants were studied from the Cardiovascular Health Study (CHS), a prospective cohort of community‐living older adults. Standard 12‐lead ECGs measured prior to MRI scan were used. MRI scans were conducted at years 4–6 and 10–11. The primary outcome was presence of incident covert brain infarcts (CBIs) on the 2nd MRI examination, excluding previous CBIs and stroke occurrence. Secondary outcomes included white matter, ventricular, and sulcal atrophy on the 1st MRI. Logistic and multiple linear regression models were used to assess the relationship between ECG findings and silent vascular brain injury.ResultsLeft axis deviation before MRI scan was related to presence of incident CBIs (odds ratio [OR]: 1.45; 95% CI: 1.01–2.08,p= .047). A long QT interval was associated with severe white matter hyperintensity (OR: 1.36; 95% CI: 1.04–1.77,p= .024). Minor Q and QS waves with ST‐T abnormalities were positively related to sulcal atrophy (β: 0.43, 95% CI: 0.06–0.81,p= .023).ConclusionsOur study found that ECG abnormalities were related to presence of CBIs, white matter hyperintensity, and sulcal atrophy on MRI in a stroke‐free relderly population. Specifically, those with left axis deviation had an increased risk of presence of CBIs.