Graded Association of Familial Stroke Burden with Asymptomatic Cerebrovascular Lesion

Although family history is an established risk factor for stroke, the extent to which familial aggregation of stroke correlates with subclinical cerebrovascular burden on magnetic resonance imaging (MRI) remains unclear.

We conducted a cross-sectional analysis of adults who underwent brain health checkups at a single center in Tokyo, Japan. Family history of ischemic stroke and intracerebral hemorrhage were assessed separately for parents, grandparents, siblings, and offspring, and participants were classified into five categories: no family history, both parents affected, father affected, mother affected, or other relatives affected. Outcomes were MRI-detected asymptomatic infarction and cerebral microbleeds, dichotomized as present (≥1 lesion) or absent. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) in two models: model 1 was adjusted for age and sex, and model 2 was additionally adjusted for body mass index, current smoking, current alcohol consumption, and histories of hypertension, diabetes mellitus, and dyslipidemia.

Among 60,310 stroke-free participants, asymptomatic infarction and cerebral microbleeds were each present in approximately 2%. In model 2, compared with participants with no family history, those with a biparental history of ischemic stroke had higher odds of asymptomatic infarction (OR 1.65, 95% CI 1.01-2.69). Similarly, a biparental history of intracerebral hemorrhage was associated with cerebral microbleeds (OR 1.92, 95% CI 1.11-3.33).

In this urban Japanese brain screening cohort, biparental stroke history may serve as a pragmatic marker of increased subclinical cerebrovascular burden and help identify individuals who could benefit from earlier preventive strategies.