Association of hemostatic variables with MRI-detected cerebral abnormalities: the atherosclerosis risk in communities
M W Knuiman1, A R Folsom, L E Chambless
1Department of Public Health, University of Western Australia, Perth, WA, Australia.
Objectives:
Population-based and clinical prospective studies have shown independent associations of several hemostatic factors with ischemic heart disease and stroke. MRI-detected cerebral infarcts and white matter lesions are often detected in elderly individuals without clinical disease. It has been hypothesized that these types of lesions are often the consequence of cerebral ischemic damage and may be the precursors of clinical stroke.
Methods:
This study examined the relation between a range of hemostatic factors measured at baseline in middle-aged participants who were free of diagnosed cardiovascular disease in the Atherosclerosis Risk in Communities Study and MRI-detected cerebral abnormalities at a 6-year follow-up examination.
Results:
Plasma fibrinogen and perhaps von Willebrand factor were associated positively, and protein C was associated negatively, with cerebral infarctions. Adjusted for other risk factors, the odds ratio for cerebral infarction was 1.21 (95% confidence interval, CI = 1.02-1.44) per standard deviation increment for fibrinogen, 1.15 (95% CI = 0.97-1.37) per standard deviation increment for von Willebrand factor, and 0.77 (95% CI = 0.62-0.95) per standard deviation increment for protein C. No hemostatic factor, however, was associated with white matter disease.
Conclusions:
This study has only a follow-up MRI, and it is likely that some MRI lesions were present at baseline. Nevertheless, increased levels of fibrinogen and von Willebrand factor and reduced levels of protein C appear to be associated with cerebral infarction identified by MRI.
Insights
Elevated fibrinogen and von Willebrand factor, along with lower protein C levels, are linked to cerebral infarction. These hemostatic factors may play a role in the development of stroke, even in individuals without diagnosed cardiovascular disease.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Hematology
Background:
- Hemostatic factors are independently associated with ischemic heart disease and stroke.
- Cerebral infarcts and white matter lesions on MRI are common in older adults and may indicate prior ischemic damage or precede clinical stroke.
Purpose of the Study:
- To investigate the relationship between baseline hemostatic factors and MRI-detected cerebral abnormalities in middle-aged adults without diagnosed cardiovascular disease.
Main Methods:
- Prospective cohort study (Atherosclerosis Risk in Communities Study).
- Measured various hemostatic factors at baseline.
- Assessed MRI-detected cerebral infarcts and white matter lesions at 6-year follow-up.
Main Results:
- Fibrinogen and von Willebrand factor showed a positive association with cerebral infarctions.
- Protein C demonstrated a negative association with cerebral infarctions.
- No hemostatic factor was associated with white matter disease.
Conclusions:
- Increased fibrinogen and von Willebrand factor, and decreased protein C, are associated with MRI-identified cerebral infarction.
- These findings suggest a potential role for these hemostatic factors in the pathogenesis of cerebral infarction.
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