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Published on: July 28, 2013
Racial/Ethnic Variation in White Matter Hyperintensity Progression in the ACCORDION MIND Study
Alison L Herman1, Adam de Havenon1, Guido J Falcone1
1Department of Neurology, Yale University School of Medicine, New Haven, CT.
Background:
White matter hyperintensities (WMHs) are linked to cognitive decline and stroke. We investigate the impact of race on WMH progression in the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORDION MIND) trial.
Materials And Methods:
The primary outcome is WMH progression in milliliters, evaluated by fitting linear regression to WMH volume on the month 80 magnetic resonance imaging (MRI) and including the WMH volume on the baseline MRI. The primary predictor is patient race, with the exclusion of patients defined as "other" race. We also derived predicted probabilities of our outcome for systolic blood pressure (SBP) levels.
Results:
We included 276 patients who completed the baseline and month 80 MRI, of which 207 (75%) were White, 48 (17%) Black, and 21 (8%) Hispanic. During follow-up, the mean number of SBP, low-density lipoprotein (LDL), and A1c measurements per patient was 21, 8, and 15. The median (IQR) WMH progression was 1.5 mL (0.5 to 3.9) for Black patients, 1.0 mL (0.4 to 4.0) for Hispanics, and 1.3 mL (0.5 to 2.7) for Whites (Kruskal-Wallis test, P =0.59). In the multivariate regression model, Black, compared with White, patients had significantly more WMH progression (β Coefficient 1.26, 95% confidence interval 0.45 to 2.06, P =0.002). Hispanic, compared with White, patients neither have significantly different WMH progression ( P =0.392), nor was there a difference when comparing Hispanic to Black patients ( P =0.162). The predicted WMH progression was significantly higher for Black compared with White patients across a mean SBP of 117 to 139 mm Hg.
Conclusions:
Black diabetic patients in Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORDION MIND) have a higher risk of WMH progression than White patients across a normal range of SBP.
Insights
Black diabetic patients experience greater white matter hyperintensities (WMH) progression than White patients. This finding highlights racial disparities in WMH development, even with controlled blood pressure.
Area of Science:
- Neurology
- Cardiovascular Disease Research
- Medical Imaging Analysis
Background:
- White matter hyperintensities (WMH) are associated with cognitive decline and stroke risk.
- Investigating racial differences in WMH progression is crucial for understanding disease disparities.
Purpose of the Study:
- To examine the impact of race on the progression of white matter hyperintensities (WMH) within the ACCORDION MIND trial.
- To assess if racial disparities in WMH progression persist across varying systolic blood pressure levels.
Main Methods:
- Linear regression analysis was used to evaluate WMH progression (in milliliters) from baseline to 80 months.
- Patient race was the primary predictor, with "other" race categories excluded.
- Systolic blood pressure (SBP) levels were analyzed for their influence on WMH progression.
Main Results:
- Black patients showed significantly more WMH progression (β=1.26, P=0.002) compared to White patients.
- Hispanic patients did not exhibit significantly different WMH progression compared to White or Black patients.
- Predicted WMH progression was higher for Black patients across a mean SBP range of 117-139 mmHg.
Conclusions:
- Black diabetic patients in the ACCORDION MIND trial have a higher risk of WMH progression than White patients.
- These disparities are evident even within a normal range of systolic blood pressure.
- The findings underscore the need to address racial inequities in cardiovascular risk management and neurological health.
