Blood Pressure and White-Matter Disease Progression in a Biethnic Cohort

Gottesman, Rebecca F.; Coresh, Josef; Catellier, Diane J.; Sharrett, A. Richey; Rose, Kathryn M.; Coker, Laura H.; Shibata, Dean; Knopman, David S.; Jack, Clifford R.; Mosley, Thomas H.

doi:10.1161/strokeaha.109.566992

Cited by 148 publications

(140 citation statements)

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“…There was no suggestion of similar differences in associations by race with pack-years, age at start of smoking, and years since quitting, and effect estimates were similar in sensitivity analyses designed to address this possibility. Similarly, while it is possible that the high prevalence of hypertension, which is strongly associated with WMH progression in black participants in ARIC, 20 masks any additional impact of smoking, analyses adjusting for hypertension and health factors were similar to primary analyses.…”

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confidence: 85%

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Smoking and white matter hyperintensity progression

et al. 2015

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Objective: Our objective was to examine the link between smoking and smoking history, including smoking intensity and cessation, overall and by race, in a biracial prospective cohort study.Methods: A subset of Atherosclerosis Risk in Communities Study participants (n 5 972, 49% black) completed brain MRI scans twice (1993-1995 and 2004-2006). We defined white matter hyperintensity (WMH) progression as an increase of $2 points on the 9-point Cardiovascular Health Study scale across scans. Participants reported information on smoking behavior at the baseline MRI and at 2 prior study visits, approximately 3 and 6 years before baseline. We used adjusted logistic regression to evaluate the association between smoking variables and WMH progression in the total sample and separately by race (black and white). Results:We found WMH progression in 23% of participants (30% of black participants, 17% of white participants). Overall, being a current smoker 6 years before baseline was associated with WMH progression. In race-stratified analyses, we found adverse associations with smoking status at multiple time points and persistent smoking in white but not in black participants. However, we found no statistical support for effect modification by race for most of these analyses. Increasing pack-years of smoking was associated with greater risk of WMH progression, while time since quitting and age at smoking initiation were not associated with WMH progression, with little indication of differences in these associations by race.Conclusions: Our findings concur with previous studies suggesting a relationship between smoking and WMH progression, and further demonstrate a dose-dependent association.Neurology ® 2015;84:841-848 GLOSSARY ARIC 5 Atherosclerosis Risk in Communities; BMI 5 body mass index; CHD 5 coronary heart disease; CHS 5 Cardiovascular Health Study; IPAW 5 inverse probability of attrition weight; WMH 5 white matter hyperintensity.Smoking may be related to white matter hyperintensities (WMH), also called leukoaraiosis, which reflect subclinical small vessel disease, specifically white matter damage due to hypoperfusion, thrombosis of arterioles, or a leaky blood-brain barrier.1-3 Cross-sectional studies reporting on the association between smoking and WMH severity are mixed. [4][5][6][7][8][9][10][11] Prospective studies of smoking and WMH progression are likely more informative. Associations with progression provide stronger evidence for a causal relation, because studies of within-person change are less susceptible to confounding, and WMH progression may be more strongly associated with clinically relevant outcomes than WMH severity.12 The few studies reporting on smoking and WMH progression, including our own, suggest an association between current smoking and WMH progression. [13][14][15][16] However, these studies crudely classified smoking (e.g., current/ former/never). Demonstration of a dose-response relationship and declines in risk with smoking cessation would strengthen causal claims. Furthermore, ...

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confidence: 85%

“…Technical details are available elsewhere. 13,19,20 For both sets of MRIs, proton density-weighted images were viewed and assigned a score of 0 to 9 according to the WMH scale developed for the Cardiovascular Health Study (CHS). 8,9,21 Subcortical and periventricular WMH were evaluated together.…”

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confidence: 99%

Smoking and white matter hyperintensity progression

et al. 2015

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“…Details of the visit 3 and brain MRI visit scanning/interpretation protocols have been published. 13,20,21 Infarcts were defined based on signal characteristics: bright on T2 and proton density scans and dark on T1 images. Ventricular size and sulcal width were estimated from axial T1-weighted images using a validated 0-9 scale.…”

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confidence: 99%

“…Change in WMH volume from visit 3 to the brain MRI visit was calculated by subtracting the WMH volume at the brain MRI visit 20 (using quantitative WMH volumes) minus the estimated WMH volume at visit 3 (using a validated prediction equation that related WMH volume to visit 3 visual grade) (0-9 scale) (R 2 5 0.8). 20 For WMH volume change, which was categorized into quintiles because of non-normal distribution, the outcome was odds of being in the top quintile of change compared to the bottom 4 quintiles, using prior methodology.…”

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confidence: 99%

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

et al. 2015

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Objective: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort.Methods: Baseline and follow-up cognitive testing (n 5 2,386) and MRI scans with standardized assessments (n 5 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE e4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging.Results: Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized.Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p , 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n 5 885) underwent MRI scans separated by 10.5 years. Hospitalization (n 5 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. Hospitalizations in older adults (.65 years) account for more than one third of community hospital stays and result in substantial morbidity and mortality. [1][2][3] Recently, evidence has emerged that hospitalization may be associated with long-term cognitive decline and incident dementia, even in the absence of hospitalization for stroke or head trauma. [4][5][6] However, the association between hospitalization and cognitive decline has not been well-characterized, although establishing the magnitude and etiology of cognitive decline would be crucial to develop targeted prevention strategies. Conclusions:In order to characterize the independent associations of hospitalization with cognitive change, accurate assessment of a patient's prehospitalization comorbidities is critical, since hospitalization might only be a marker of vulnerability. However, previous studies have been limited by excessive reliance on patient self-reported comorbidities, which may lead to misclassification with residual confounding, and lack of accounting for APOE e4 status. The potential

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“…Therefore, WMH volumes at visit 3 were estimated from categorical WMH scores at visit 3 using a prediction equation (R 2 5 0.80) previously used in ARIC. 10 This equation was derived from a quadratic relationship between categorical WMH score (using the same CHS scale) and volumetric WMH measurements were obtained from the same scans at the brain MRI visit. Change in WMH volume was calculated by subtracting the estimated WMH volume at visit 3 (calculated from this equation) from the WMH volume at the brain MRI visit.…”

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confidence: 99%

Migraine and white matter hyperintensities

et al. 2013

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Objective: Migraine is associated with white matter hyperintensities (WMH) cross-sectionally, but its effect on WMH progression is uncertain.Methods: Participants in the Atherosclerosis Risk in Communities cohort study (n 5 10,924) completed a standardized headache questionnaire between 1993 and 1995. A subset of participants (n 5 1,028) received 2 MRIs 8 to 12 years apart: once at the time of headache ascertainment, and again from 2004 to 2006. WMH were quantified using both a visually graded score (0-9) and semiautomated volumetric analysis. Linear and logistic regression models adjusted for age, sex, and other vascular risk factors were constructed.Results: Individuals who had migraine without aura were cross-sectionally associated with an 87% greater odds of having a WMH score $3 than individuals without headache (adjusted odds ratio 5 1.87; 95% confidence interval [CI]: 1.04, 3.37). Participants with migraine had an average of 2.65 cm 3 more WMH than those without headache (95% CI: 0.06, 5.24). However, there was no significant difference in WMH progression over the study period between individuals with and without migraine (1.58 cm 3 more progression for individuals with migraine compared to those without; 95% CI: 20.37, 3.53). Conclusion:Migraine is associated with WMH volume cross-sectionally but not with WMH progression over time. This suggests that the association between migraine and WMH is stable in older age and may be primarily attributable to changes occurring earlier in life, although further work is needed to confirm these findings. Several epidemiologic studies, including 2 recent population-based studies, 1,2 have demonstrated a cross-sectional association between migraine and white matter hyperintensities (WMH), a common MRI finding that is believed to represent chronic small-vessel cerebrovascular disease.3 However, these studies differ regarding the effect of sex and the presence of aura on the association between migraine and WMH. A follow-up of one of these studies found that migraine was associated with greater WMH progression, but that this was specific to women with supratentorial deep WMH. 4 To further investigate the relationship between migraine and white matter disease, we analyzed data from the Atherosclerosis Risk in Communities (ARIC) brain MRI study. We hypothesized that a history of migraine would be associated with both baseline WMH volume and WMH progression over time.METHODS Study design and participants. The ARIC study is an ongoing prospective cohort study designed to investigate the etiology of atherosclerosis and the variation in cardiovascular disease and risk factors by race and socioeconomic status.

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Blood Pressure and White-Matter Disease Progression in a Biethnic Cohort

Cited by 148 publications

References 23 publications

Smoking and white matter hyperintensity progression

Smoking and white matter hyperintensity progression

Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

Migraine and white matter hyperintensities

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