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Risk factors for microangiopathy-related cerebral damage in the Austrian stroke prevention study
Abstract:
Microangiopathy-related cerebral damage (MARCD) represents a common incidental MRI observation in the elderly. The risk factors of such findings are widely unknown. We therefore performed MRI in 349 randomly selected volunteers (ages 50 to 70 years) without neuropsychiatric disease, and evaluated the association of MARCD with conventional and recently suggested cerebrovascular risk factors such as apolipoprotein E genotypes, plasma concentrations of essential antioxidants and anticardiolipin antibody titres. MARCD was defined as evidence of early confluent and confluent deep white matter hyperintensities and lacunes. It was present in 71 (20.3%) subjects. Individuals with MARCD were older than those without such findings (62.7 years vs 59.6 years; P=0.0001). They had a higher rate of arterial hypertension (45.1% vs 28.1%; P=0.006) and cardiac disease (50.7% vs 37.1%; P=0.04), higher systolic blood pressure readings at exam (144.4 mmHg vs 136.7 mmHg; P=0.004), and higher serum fibrinogen concentrations (327.1 mg/dl vs 292.5 mg/dl; P=0.001). Their levels of total cholesterol (217.6 mg/dl vs 231.2; P=0.009), apolipoprotein A-I (167.3 mg/dl vs 177.4 mg/dl, P=0.02), lycopene (0.17 micromol/l vs 0.24 micromol/l; P=0.003), retinol (1.91 micromol/l vs 2.10 micromol/l; P=0.02) and alpha-tocopherol (27.55 micromol/l vs 31.14 micromol/l; P=0.001) were significantly lower. Forward stepwise regression analysis created a model of independent predictors of MARCD with age entering first (odds ratio 2.01/10 years), fibrinogen second (odds ratio 2.45/100 mg/dl), alpha-tocopherol third (odds ratio 0.55/10 micromol/l), and arterial hypertension fourth (odds ratio 1.96). The association of MARCD with various treatable clinical conditions may have preventive implications.
Insights
Microangiopathy-related cerebral damage (MARCD) is common in older adults. Key risk factors include age, hypertension, high fibrinogen, and lower antioxidant levels like alpha-tocopherol, suggesting potential preventive strategies.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Microangiopathy-related cerebral damage (MARCD) is a frequent incidental finding on MRI in elderly individuals.
- Risk factors contributing to MARCD are not well-established, necessitating further investigation.
Purpose of the Study:
- To identify conventional and novel cerebrovascular risk factors associated with MARCD in a healthy elderly population.
- To evaluate the association of MARCD with genetic factors, antioxidant levels, and antibody titers.
Main Methods:
- MRI scans were performed on 349 healthy volunteers aged 50-70 years.
- MARCD was defined by deep white matter hyperintensities and lacunes.
- Associations were analyzed with risk factors including age, hypertension, cardiac disease, blood pressure, fibrinogen, cholesterol, apolipoproteins, and antioxidants (lycopene, retinol, alpha-tocopherol).
Main Results:
- MARCD was observed in 20.3% of subjects and was associated with older age, arterial hypertension, and cardiac disease.
- Individuals with MARCD had higher systolic blood pressure and serum fibrinogen levels.
- Lower levels of total cholesterol, apolipoprotein A-I, lycopene, retinol, and alpha-tocopherol were significantly associated with MARCD.
Conclusions:
- Independent predictors of MARCD include age, fibrinogen, alpha-tocopherol, and arterial hypertension.
- The link between MARCD and treatable conditions suggests potential avenues for preventive interventions.