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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Assessment of cerebral small vessel disease predicts individual stroke risk
Mariëlle M F Poels1, Ewout W Steyerberg, Renske G Wieberdink
1Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Background:
Despite several known risk factors it is still difficult to foresee who will develop a stroke and who will not. Vascular brain damage, visualised with MRI, reflects how the brain tolerates the effects of vascular risk factors and may therefore be relevant in predicting individual stroke risk.
Objective:
To examine whether the presence of small vessel disease on brain MRI could improve the prediction of stroke beyond the classic stroke risk factors from the 1991 Framingham Stroke Risk Function.
Methods:
1007 community-dwelling elderly people, free of stroke at baseline were included in the study. Small vessel disease--that is, the presence of silent brain infarcts (SBI) and white matter lesions (WML), was scored on MRI scans obtained in 1995-6. 10-Year stroke risk prediction was assessed by the C statistic and by reclassification adding SBI and WML to a risk model including the classic stroke risk factors.
Results:
During 10-years of follow-up 99 strokes occurred. Individual stroke risk prediction significantly improved from 0.73 (95% CI 0.67 to 0.78) to 0.75 (0.69 to 0.80) in men and from 0.69 (0.64 to 0.75) to 0.77 (0.71 to 0.82) in women after inclusion of SBI and periventricular WML to the stroke risk factors. Reclassification occurred mainly in the intermediate stroke risk group (men 26%; women 61% reclassified).
Conclusions:
Assessment of small vessel disease with MRI beyond the classic stroke risk factors improved the prediction of subsequent stroke, especially in women with an intermediate stroke risk. These findings support the use of MRI as a possible tool for better identifying people at high risk of stroke.
Insights
Brain MRI findings of small vessel disease, including silent brain infarcts and white matter lesions, significantly improve stroke risk prediction beyond traditional factors. This enhanced prediction is particularly beneficial for identifying intermediate-risk individuals, especially women.
Area of Science:
- Neurology
- Radiology
- Epidemiology
Background:
- Predicting individual stroke risk remains challenging despite known risk factors.
- Vascular brain damage visualized by MRI may indicate how well the brain tolerates vascular risk factors, suggesting its relevance for stroke risk prediction.
Purpose of the Study:
- To determine if brain MRI-detected small vessel disease (SVD) enhances stroke risk prediction beyond established Framingham Stroke Risk Function factors.
- Investigate the utility of silent brain infarcts (SBI) and white matter lesions (WML) in improving stroke risk stratification.
Main Methods:
- A cohort of 1007 elderly individuals, stroke-free at baseline, underwent MRI in 1995-6.
- SVD, including SBI and WML, was assessed via MRI. 10-year stroke risk was evaluated using the C statistic and reclassification analysis.
Main Results:
- Over 10 years, 99 strokes occurred. Including SBI and periventricular WML improved stroke risk prediction: C-statistic rose from 0.73 to 0.75 in men and 0.69 to 0.77 in women.
- Reclassification of stroke risk was substantial, particularly in the intermediate risk group (26% of men, 61% of women).
Conclusions:
- MRI assessment of SVD improves subsequent stroke prediction beyond classic risk factors, notably benefiting women with intermediate risk.
- These findings support the use of MRI for more accurate identification of individuals at high risk of stroke.
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