Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study

Abstract

BackgroundThe effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples.Methods and ResultsStroke‐free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non‐Hispanic white, 17% non‐Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6–9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1–1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0–1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1–4.4). White and black but not Hispanic participants had increased stroke risk (P<0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1–3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3–3.8), lacunar (HR: 4.0; 95% CI, 1.3–12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0–12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1–1.7) and nonvascular (HR: 1.2; 95% CI, 1.0–1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4–5.8).ConclusionsIn this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

“…Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) brain MRI substudy who achieved more ideal CVH at ages 18 to 30 had larger brain volumes 25 years later, but they observed no associations with normal gray or white matter volume or abnormal white matter volume 24. WMHV, brain atrophy, and SBI are all important imaging biomarkers of brain aging and predictive of future risk of stroke and dementia across study populations 9, 10, 11. These brain changes have potential as brain health markers that can be used both clinically and in research studies as intermediate or surrogate outcomes to help identify at‐risk patients.…”

“…However, although the AHA has now defined optimal brain health by the Life's Simple 7 metric, there is very limited evidence regarding its impact on biomarkers of subclinical brain aging. Subclinical brain aging biomarkers, including white matter hyperintensities, silent brain infarct (SBI), and brain atrophy, are common in the population and important risk factors for stroke as well as cognitive decline and dementia 9, 10, 11. The potential association of Life's Simple 7 and these important subclinical imaging biomarkers of brain aging is largely unknown and the motivation for the current analysis.…”

Plasma total‐tau as a biomarker of stroke risk in the community

“…13,14 Thus, t-tau may predict the risk of incident stroke through associations with subclinical vascular brain injury. 13,14 Thus, t-tau may predict the risk of incident stroke through associations with subclinical vascular brain injury.…”

THE EFFICACY OF LONG-TERM WARFARIN THERAPY: THE IMPACT ON THE INCIDENCE OF ISCHEMIC CEREBROVASCULAR DISORDERS AND CLINICAL PREDICTORS OF DEVELOPING SUCH DISORDERS. (Results of a prospective 10-year follow-up study)

“…При этом больные нашего исследова-ния не являются искусственно отобранной ко-гортой, а представляют собой традиционных пациентов врача-кардиолога. При сравнении с данными других исследований и регистров, посвященных рутинной практике [6][7][8][9][10], па-циенты нашей выборки моложе, но в большин-стве своем тяжелее. Их средний возраст соста-вил 64,6 года, число пациентов старше 75 лет -лишь 12%, но при этом средняя сумма баллов по шкале CHA 2 DS 2 -VASc составила 3,2 ± 1,76.…”