In this sample of non-demented older persons, subcortical infarcts contributed to an increased risk of depressive symptoms as well as cognitive impairment. This depended on location in projecting white-matter tracts, and not on infarct size.
Menopause is not associated with accelerated fat gain in women with cardiovascular disease. Compared with similar-aged men, postmenopausal women show a steeper increase in VAT and a steeper decrease in SAT. These ongoing changes might add to an unfavorable metabolic profile associated with an increased risk of recurrent cardiovascular events.
Aims: Adiposity is associated with an increased but also with a decreased risk for successive vascular events or mortality in patients with different manifestations of vascular disease. In this study we directly compare the risk of general adiposity or abdominal obesity on the occurrence of new vascular events or mortality in these patients. Methods: Patients with cerebrovascular disease (CVD; n ¼ 973), coronary artery disease (CAD; n ¼ 2339) or peripheral arterial disease (PAD; n ¼ 894) were prospectively followed for the occurrence of a vascular event or death. The median follow-up was 4.5 years. Adiposity was assessed with body mass index (BMI), waist circumference (WC) and determination of intra-abdominal fat through ultrasound. Cox proportional hazards models were used to evaluate the risk for new vascular events, vascular mortality and all-cause mortality. Results: CAD patients had a 12% increased risk for vascular mortality with 1 BMI unit increase (hazard ratio (HR) 1.12; 95% confidence interval (CI) 1.05-1.20) and a 25% increased risk with 1cm increase in intra-abdominal adipose tissue (HR 1.25; 95% CI 1.12-1.39). The risk for all-cause mortality was increased by 3% (HR 1.03; 95% CI 1.01-1.05) with 1 cm increase in WC and was increased by 15% (HR 1.15; 95% CI 1.06-1.25) with 1 cm increase in intra-abdominal adipose tissue. In PAD patients there was an inverse relationship between BMI and vascular mortality (HR 0.93;) and all-cause mortality (HR 0.90; 95% CI 0.86-0.94). In CVD patients there was no relation between obesity and vascular events or mortality. Conclusion: General adiposity is associated with an increased risk for vascular mortality in CAD patients and a decreased risk for (vascular) mortality in PAD patients.
Small infarcts are among the key imaging features of cerebral small vessel
disease (CSVD), but remain largely undetected on conventional MRI. We aimed to
evaluate (1) imaging criteria for the detection of small infarcts in the caudate
nucleus on 7T MRI, (2) intra- and inter-rater agreement, (3) frequency and (4)
detection rate on 7T versus 1.5T MRI. In 90 patients (68 ± 8 years) with a
history of vascular disease from the SMART-MR study, we defined 7T imaging
criteria for cavitated and non-cavitated small infarcts in the caudate nucleus.
In a separate set of 23 patients from the SMART study, intra-rater and
inter-rater agreement was excellent for presence, number, and individual
locations (Kappa’s, ICCs, and Dice similarity coefficients ranged from 0.85 to
1.00). In the 90 patients, 21 infarcts (20 cavitated) in 12 patients were
detected on 7T (13%) compared to 7 infarcts in 6 patients on 1.5T (7%). In
conclusion, we established reproducible imaging criteria for the detection of
small infarcts in the caudate nucleus on 7T MRI and showed that 7T MRI allows
for a higher detection rate than conventional 1.5T MRI. These imaging criteria
can be used in future studies to provide new insights into the pathophysiology
of CSVD.
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