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Lesiones de la sustancia blanca cerebral, retinopatía y accidente cerebrovascular clínico incidente
Tien Yin Wong1, Ronald Klein, A Richey Sharrett
1Department of Ophthalmology, University of Wisconsin, Madison, USA. ophwty@nus.edu.sg
JAMA
|July 2, 2002
Resumen
Las lesiones de la materia blanca (LMB) relacionadas con anomalías de la retina aumentan el riesgo de accidente cerebrovascular en adultos de mediana edad. La detección temprana de WML y retinopatía puede ayudar a predecir y prevenir el accidente cerebrovascular clínico.
Área de la Ciencia:
- Neurología Neurología.
- Oftalmología Oftalmología.
- La medicina vascular es una medicina vascular.
Sus antecedentes:
- Se sospecha que las lesiones de materia blanca (WML) en las exploraciones cerebrales se derivan de problemas microvasculares y preceden al accidente cerebrovascular.
- Existen datos clínicos limitados para confirmar el origen microvascular de las WML y su valor predictivo para el accidente cerebrovascular.
Objetivo del estudio:
- Para investigar la asociación entre WMLs, cambios microvasculares retinianos y la incidencia de accidente cerebrovascular clínico.
- Para analizar estas relaciones en una cohorte de individuos sanos de mediana edad.
Principales métodos:
- Se utilizaron datos del Estudio de Riesgo de Aterosclerosis en Comunidades (ARIC), una cohorte prospectiva basada en la población.
- Se incluyeron 1684 participantes de entre 51 y 72 años que se sometieron a resonancia magnética cerebral y fotografía de retina.
- Se evaluaron WMLs a través de resonancia magnética y anomalías de la retina, correlacionándolas con accidentes cerebrovasculares incidentes durante un seguimiento mediano de 4.7 años.
Principales resultados:
- Los individuos con retinopatía mostraron una mayor probabilidad de LME (OR, 2.5).
- La incidencia de accidente cerebrovascular a los 5 años fue elevada en aquellos con WML (RR, 3.4) y retinopatía (RR, 4.9).
- Se observó un riesgo significativamente mayor de accidente cerebrovascular en individuos con LMC y retinopatía (RR, 18.1) en comparación con aquellos sin ninguna de las dos.
Conclusiones:
- Las LME cerebrales en individuos de mediana edad están asociadas con anomalías microvasculares de la retina.
- La presencia de WML aumenta de forma independiente el riesgo de accidente cerebrovascular clínico.
- Las LMA concomitantes y la retinopatía elevan notablemente el riesgo de accidente cerebrovascular, lo que subraya el vínculo entre la salud cerebrovascular y la retina.
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