Higher Burden of Cerebral Small Vessel Disease Is Associated With Risk of Incident Stroke in Community-Dwelling
Adlin Pinheiro1,2, Hugo Aparicio2,3, Vasileios-Arsenios Lioutas2,4
1Department of Biostatistics Boston University School of Public Health Boston MA USA.
Insights
A high burden of cerebral small vessel disease (CSVD) markers significantly increases stroke risk. A multimarker CSVD score better identifies stroke risk than the Framingham Stroke Risk Profile (FSRP) alone.
Area of Science:
- Neurology
- Cardiovascular Research
- Public Health
Background:
- Cerebral small vessel disease (CSVD) markers are common.
- High CSVD burden is linked to increased stroke and dementia risk.
- Multimarker CSVD scores may improve risk prediction.
Purpose of the Study:
- To assess the association between a multimarker CSVD score and incident stroke risk.
- To compare the predictive performance of the CSVD score against the Framingham Stroke Risk Profile (FSRP).
Main Methods:
- Included Framingham Heart Study participants (≥55 years) without prior stroke or dementia.
- Developed a multimarker CSVD score (0-5 points) based on MRI markers: cerebral microbleeds, perivascular spaces, white matter hyperintensities, infarcts, and siderosis.
- Used multivariable Cox regression to analyze the relationship between CSVD score and stroke risk.
Main Results:
- Among 1154 participants, 92 (8%) experienced stroke over 8.6 years.
- Individuals with ≥3 CSVD markers had a 2.62-fold increased stroke risk (adjusted HR).
- The CSVD score and FSRP showed similar model discrimination for stroke risk.
Conclusions:
- Elevated CSVD burden independently predicts stroke risk, exceeding FSRP's predictive capacity.
- The multimarker CSVD score can aid in identifying at-risk individuals for early intervention.
- Integrating CSVD burden assessment into clinical practice may enhance stroke prevention strategies.
Background:
Mild manifestations of individual cerebral small vessel disease (CSVD) markers are common and may not denote increased risk, but high CSVD burden identifies individuals at increased risk of stroke and dementia. Scores incorporating multiple individual CSVD markers may better identify a person's risk. We related a multimarker CSVD score to risk of incident stroke and compared it with the Framingham Stroke Risk Profile (FSRP) in community-dwelling individuals.
Methods:
Framingham Heart Study participants aged ≥55 years, free of stroke and dementia, and with brain magnetic resonance imaging ratings of CSVD markers were included. A multimarker CSVD score reflecting increasing CSVD burden was used, assigning 1 point each for presence of cerebral microbleeds, severe perivascular spaces, extensive white matter hyperintensities, covert brain infarcts, and cortical superficial siderosis. Multivariable Cox proportional hazards regression analyses were used to relate CSVD score to incident stroke.
Results:
Among 1154 participants (46% men, mean age 70.9±8.7 years), 92 (8%) developed stroke over a median follow-up of 8.6 years (Q1-Q3: 5.1-12.5). In models adjusting for age, sex, time interval between clinic exam and magnetic resonance imaging, Framingham cohort, and FSRP, those with ≥3 markers had increased risk of stroke (hazard ratio [HR], 2.62 [95% CI, 1.17-5.88]). In comparison, a 5% increase in FSRP was also associated with increased risk (adjusted HR, 1.16 [95% CI, 1.04-1.29]). The FSRP and CSVD score had similar model discrimination metrics.
Conclusions:
Higher CSVD burden is associated with increased risk of stroke, beyond the effect explained by risk factors in the FSRP. These findings support consideration of CSVD burden to identify risk of stroke in community-dwelling individuals for early implementation of preventive strategies.
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