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Cerebral Microbleeds as Predictors of Mortality: The Framingham Heart Study
José R Romero1, Sarah R Preis2, Alexa Beiser2
1From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.). joromero@bmc.org.
Background And Purpose:
Cerebral microbleeds (CMB) represent a common magnetic resonance imaging marker of cerebral small vessel disease, increasingly recognized as a subclinical marker of stroke and dementia risk. CMB detection may reflect the cumulative effect of vascular risk burden and be a marker of higher mortality. We investigated the relation of CMB to risk of death in community dwelling participants free of stroke and dementia.
Methods:
We evaluated 1963 Framingham Original and Offspring Cohort participants (mean age 67 years; 54% women) with available brain magnetic resonance imaging and mortality data. Using Cox proportional hazards models, we related CMB to all-cause, cardiovascular, and stroke-related mortality.
Results:
Participants with CMB (8.9%) had higher prevalence of cardiovascular risk factors and use of preventive medications. During a mean follow-up of 7.2±2.6 years, we observed 296 deaths. In age- and sex-adjusted analysis, CMB were associated with increased all-cause mortality (hazards ratio, 1.39; 95% confidence interval 1.03-1.88), a relation that was no longer significant after adjustment for cardiovascular risk and preventive medication use (hazards ratio, 1.15; 95% confidence interval, 0.82-1.63).
Conclusions:
CMBs may represent the deleterious effect of cardiovascular risk factors in the cerebral vasculature. Although their presence was associated with increased all-cause mortality, the effect was no longer present after accounting for vascular risk factors and preventive treatment use. Further studies are required to clarify the role of cardiovascular preventive therapies for prevention of mortality in persons with incidental detection of CMB.
Insights
Cerebral microbleeds (CMB) are linked to higher mortality risk, but this association disappears when accounting for cardiovascular risk factors and treatments. Further research is needed on preventive therapies for individuals with incidental CMB detection.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Cerebral microbleeds (CMB) are common MRI findings in cerebral small vessel disease.
- CMB are increasingly recognized as indicators of stroke and dementia risk.
- CMB may reflect cumulative vascular risk and predict higher mortality.
Purpose of the Study:
- To investigate the relationship between cerebral microbleeds (CMB) and the risk of death.
- Study focused on community-dwelling individuals without prior stroke or dementia.
Main Methods:
- Evaluated 1963 participants from the Framingham Original and Offspring Cohorts.
- Utilized brain MRI and mortality data.
- Employed Cox proportional hazards models to assess CMB association with all-cause, cardiovascular, and stroke-related mortality.
Main Results:
- 8.9% of participants had CMB, with higher prevalence of cardiovascular risk factors.
- CMB were associated with increased all-cause mortality in age- and sex-adjusted analyses (HR, 1.39).
- This association was not significant after adjusting for cardiovascular risk factors and preventive medication use (HR, 1.15).
Conclusions:
- CMB may indicate cerebrovascular damage from cardiovascular risk factors.
- The increased mortality risk linked to CMB diminishes when vascular risk factors and treatments are considered.
- Further studies are needed to clarify the role of preventive therapies in managing mortality risk in individuals with incidental CMB.