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Stroke risk profile predicts white matter hyperintensity volume: the Framingham Study
Tom Jeerakathil1, Philip A Wolf, Alexa Beiser
1Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Background And Purpose:
Previous studies of cardiovascular risk factors and white matter hyperintensity (WMH) on brain MRI have been limited by the failure to exclude symptomatic cerebrovascular disease and dementia or by the use of semiquantitative rather than quantitative methods to measure WMH volume (WMHV). We examined the relationship between Framingham Stroke Risk Profile (FSRP) and WMHV measured quantitatively in a stroke and dementia-free subset of the Framingham Offspring Cohort.
Methods:
Brain MRI was performed in 1814 members of the Framingham Offspring Cohort. Pixel-based quantitative measures of WMHV corrected for head size were obtained using a semiautomated algorithm. WMHV was not normally distributed and therefore was log-transformed (LWMHV). The FSRP and its component risk factors measured a mean of 7.5 years before MRI were related to both continuous measures of LWMHV and to the presence of large volumes of LWMHV (LWMHV-large). All analyses were adjusted for age and sex.
Results:
FSRP was strongly associated with LWMHV and LWMHV-large. Age, smoking, history of cardiovascular disease, hypertension, and left ventricular hypertrophy by electrocardiogram were all significantly related to LWMHV or LWMHV-large.
Conclusions:
FSRP and several cardiovascular risk factors were related to both WMHV measured continuously and to a categorical designation of large volumes of WMH. These findings provide strong evidence of a vascular basis for WMH.
Insights
The Framingham Stroke Risk Profile (FSRP) and its risk factors are linked to white matter hyperintensity (WMH) volume in individuals without stroke or dementia, suggesting a vascular basis for WMH.
Area of Science:
- Neuroimaging
- Cardiovascular Epidemiology
- Cerebrovascular Health
Background:
- Previous studies on cardiovascular risk factors and white matter hyperintensity (WMH) were limited by excluding symptomatic cerebrovascular disease and dementia.
- Semiquantitative methods for measuring WMH volume (WMHV) were often used instead of quantitative approaches.
Purpose of the Study:
- To examine the relationship between the Framingham Stroke Risk Profile (FSRP) and quantitatively measured WMHV.
- To investigate this relationship in a stroke and dementia-free subset of the Framingham Offspring Cohort.
Main Methods:
- Brain MRI was conducted on 1814 participants from the Framingham Offspring Cohort.
- Pixel-based quantitative WMHV measures, corrected for head size, were obtained using a semiautomated algorithm and log-transformed (LWMHV).
- FSRP and its components, measured 7.5 years prior to MRI, were analyzed against continuous LWMHV and large LWMHV (LWMHV-large), adjusting for age and sex.
Main Results:
- The FSRP demonstrated a strong association with both LWMHV and LWMHV-large.
- Significant relationships were found between LWMHV/LWMHV-large and age, smoking, history of cardiovascular disease, hypertension, and electrocardiogram-defined left ventricular hypertrophy.
Conclusions:
- The FSRP and several cardiovascular risk factors are associated with both continuous and categorical measures of WMHV.
- These findings strongly support a vascular etiology for white matter hyperintensities.
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