Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

Takashima, Yuki; Miwa, Yoshiro; Mori, Takahiro; Hashimoto, Manabu; Uchino, Akira; Yuzuriha, Takefumi; Sasaguri, Toshiyuki; Yao, Hiroshi

doi:10.1038/hr.2010.69

Cited by 14 publications

(14 citation statements)

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“…In only three [33,39,48] out of 15 studies in which an association was sought has tobacco been identified as a statistically significant risk factor for SBI [see Additional file 4: Table S3]. Of particular note is that, although the Rotterdam Scan Study identified a statistically significant increase in clinically apparent stroke (OR: 3.1; 95% CI: 0.6, 1.5), no such association was demonstrated for SBI even among the heaviest smokers with ≥20 pack year histories (OR: 1.0; 95% CI: 0.6, 1.5) [38].…”

Section: Lifestyle Factors Tobaccomentioning

confidence: 99%

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Fanning

Wong

2014

BMC Medicine

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Background: Cerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI). SBIs are a relatively new consideration as improved imaging has facilitated recognition of their occurrence. However, the true incidence, prevalence and risk factors associated with SBI remain controversial. Methods: Systematic searches of the Medline and EMBASE databases from 1946 to December 2013 were performed to identify original studies of population-based adult cohorts derived from community surveys and routine health screening that reported the incidence and prevalence of magnetic resonance imaging (MRI)-determined SBI. Results: The prevalence of SBI ranges from 5% to 62% with most studies reported in the 10% to 20% range. Longitudinal studies suggest an annual incidence of between 2% and 4%. A strong association was seen to exist between epidemiological estimates of SBI and age of the population assessed. Hypertension, carotid stenosis, chronic kidney disease and metabolic syndrome all showed a strong association with SBI. Heart failure, coronary artery disease, hyperhomocysteinemia and obstructive sleep apnea are also likely of significance. However, any association between SBI and gender, ethnicity, tobacco or alcohol consumption, obesity, dyslipidemia, atrial fibrillation and diabetes mellitus remains unclear. Conclusions: SBI is a remarkably common phenomenon and endemic among older people. This systematic review supports the association of a number of traditional vascular risk factors, but also highlights disparities between clinically apparent and silent strokes, potentially suggesting important differences in pathophysiology and warranting further investigation.

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Section: Lifestyle Factors Tobaccomentioning

confidence: 99%

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Fanning

Wong

2014

BMC Medicine

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“…We have reported a male predominance in SBI, which was largely due to a higher prevalence of alcohol intake and smoking in men than women in our population. 28 In the same context, frontal lobe dysfunction was related to male sex in model 1 but not in the final multivariate model that included MRI findings (model 2). Subcortical vascular disease and DWMLs seen in elderly subjects were associated with cognitive impairment or dementia, depression, apathy and gait disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…SBI appeared as low signal intensities on T1-weighted images, and their size was X5 mm as previously described. 28 We differentiated enlarged perivascular spaces from SBI based on their location, The logarithmically transformed MST scores and eGFR were distributed near normally.…”

Section: Assessment Of Mri Findingsmentioning

confidence: 99%

“…Vascular risk factors were defined as previously described. 28 Briefly, arterial hypertension was considered as present if a subject had a history of repeated blood pressure recordings above 140/90 mm Hg or the subject was being treated for hypertension. Diabetes mellitus was defined as having a fasting plasma glucose level 47.77 mmol l À1 and/or HbA1c 46.0% or a previous diagnosis of diabetes mellitus.…”

Section: Definition Of Vascular Risk Factorsmentioning

confidence: 99%

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Chronic kidney disease and subclinical lacunar infarction are independently associated with frontal lobe dysfunction in community-dwelling elderly subjects: the Sefuri brain MRI study

et al. 2011

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Although recent studies have found that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment in population-based cohorts, the mechanisms of cognitive impairment in subjects with CKD are unclear. We examined 503 elderly subjects (mean age: 72.4 years), who were living independently at home without apparent dementia, using MRI. The subject was judged as having frontal lobe dysfunction if the scores on the modified Stroop test were higher than the fifth quintile for each given decade. Serum creatinine values, measured by the enzymatic method, were used for the Japanese equation of estimated glomerular filtration rate (eGFR). Subjects in the frontal lobe dysfunction group tended to have higher blood pressure, lower eGFR and more lacunar infarcts, and were less educated. When possible confounders were entered into the multivariate logistic regression model, the independent predictors of frontal lobe dysfunction were eGFR (odds ratio 0.854; 95% confidence interval (CI) 0.743-0.983 per 10 ml min À1 per 1.73 m 2 ) and the number of lacunar infarction (odds ratio 1.460; 95% CI 1.127-1.892). The mean of the logarithmically transformed Stroop test scores in the eGFRo60 ml min À1 per 1.73 m 2 group was 1.376 (95% CI 1.301-1.451), which was significantly higher than that (1.250) for the eGFR 60-89 ml min À1 per 1.73 m 2 group (95% CI 1.215-1.285) (P¼0.009) and tended to be higher than that (1.264) for the eGFR X90 ml min À1 per 1.73 m 2 group (95% CI 1.188-1.340) (analysis of covariance, adjusted for age). The present study showed that CKD and subclinical lacunar infarction independently contributed to frontal lobe dysfunction in healthy elderly subjects.

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“…In this issue of Hypertension Research, Takashima et al 12 focus on the gender difference in SBI incidence among Japanese people with a population-based, cross-sectional analysis. The study comprised 266 men and 414 women with a mean age of 64.5 years.…”

mentioning

confidence: 99%

Listening to the sound of silence between men and women

Sakamoto

Mogi

et al. 2010

Hypertens Res

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S troke is a major public health problem that not only is the third leading cause of death in Japan but also induces functional disabilities and cognitive decline. A preventive approach to ischemic brain damage and neuronal loss leads to an improved quality of life in individuals. Possible gender differences have been reported in stroke. For example, most epidemiological studies have shown that men have a higher stroke incidence than women. 1 Such a gender difference in stroke incidence might be caused by the beneficial effects of estrogen on the brain in premenopausal women. In basic experiments using animal models, estrogen appeared to protect against ischemic brain damage by protection of the endothelial function and neurons. 2,3 However, the stroke incidence was increased in postmenopausal women whose serum estradiol level was the same as or less than the level in men. Conversely, the Women's Health Initiative clinical trials on hormone therapy raised an alert that estrogen treatment after menopause increases the risk of stroke and venous thromboembolic disease. 4 Therefore, the effect of estrogen is not a simple answer for explaining the gender difference in stroke incidence. Silent brain infarction (SBI) is identified by brain imaging in healthy patients without clinical symptoms and has been investigated since the 1990s. 5 The incidence of SBI in the general population is relatively high; overall, its prevalence is around 11%. 6 The presence of SBI may allow us to clinically predict overt stroke in the future. 6,7 In Japanese patients, the risk of clinical stroke was significantly higher in subjects with SBI (around a threefold increase) than in those without SBI; 8 therefore, the presence of SBI could tell us of the need for an interventional approach to prevent the onset of severe cerebral ischemia. The risk factors for SBI, such as metabolic syndrome, 9 hypertension 10 and smoking, 6 have been reported previously. Interestingly, among older Japanese subjects, white-coat hypertensives do not show an increase in the prevalence of SBI compared with normotensives. 11 However, the predicted risk factors differ from the observed results depending on the study population. Moreover, there are few population-based studies of the gender difference in SBI incidence among Japanese people.In this issue of Hypertension Research, Takashima et al. 12 focus on the gender difference in SBI incidence among Japanese people with a population-based, cross-sectional analysis. The study comprised 266 men and 414 women with a mean age of 64.5 years. Their findings are similar to previous studies; for example, the prevalence of SBI found in this study was 11.3%. However, daily habits such as smoking and alcohol intake are quite different between men and women. Interestingly, the authors reported that a higher prevalence of such lifestyle risk factors rather than gender explains the male predominance in the incidence of SBI. Although men have a higher incidence of SBI, the gender differences disappeared after adjusting for the r...

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Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

Cited by 14 publications

References 33 publications

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

Chronic kidney disease and subclinical lacunar infarction are independently associated with frontal lobe dysfunction in community-dwelling elderly subjects: the Sefuri brain MRI study

Listening to the sound of silence between men and women

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