Cerebral White Matter Lesions Are Associated With the Risk of Stroke But Not With Other Vascular Events The 3-City Dijon Study

INSERM Unit 708, Paris, France.
Stroke (Impact Factor: 5.72). 06/2009; 40(7):2327-31. DOI: 10.1161/STROKEAHA.109.548222
Source: PubMed


White matter lesions (WMLs) have been shown to be associated with the risk of stroke in previous studies but little is known about the prediction of other vascular events. We evaluated the risk of stroke and other vascular events according to WML volume in a large population-based sample. We also studied WML volume by type (deep or periventricular) in relation to these events.
The 3-City Study is a population-based prospective cohort of people aged >or=65 years followed up for, on average, 4.9 years. Among them, 1643 participants free of prevalent vascular events had quantitative measurements of WML volume at baseline using a fully automatic method. The risks of incident major vascular events according to WML volume were evaluated using Cox proportional hazards models.
The risk of incident stroke significantly increased with increasing baseline WML volume and was multiplied by 5 for those in the highest quartile of WML volume. Nonstroke vascular events' incidence was not associated with WML volumes, whatever their type.
WMLs are an independent predictor of stroke in the elderly. This association is specific because WMLs are not associated with the risk of other vascular events.

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    • "Previously, LA is only considered as a common brain neuroimaging phenomenon that is associated with the risk of cognitive decline, incident stroke, gait disturbance and falls, and dementia ( Garde et al., 2005 ; Ross et al., 2005 ; Au et al., 2006 ; Bokura et al., 2006 ; O ' Sullivan, 2008 ; Buyck et al., 2009 ; Debette and Markus, 2010 ). Pathologically , LA is predominantly considered to represent incomplete ischemia, with the following common pathological characterizations: widespread perivascular rarefaction of myelin, patchy demyelination, partial loss of axons and oligodendroglial cells, mild reactive astrocytic gliosis, and sparsely distributed macrophages as well as disruption of ependyma ( Brun and Englund, 1986 ; Babikian and Ropper, 1987 ; Fazekas et al., 1998 ; Pantoni, 2002 ; Kim et al., 2008 ; Schmidt et al., 2011 ). "
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    ABSTRACT: Leukoaraiosis (LA), also called white matter lesions (WMLs) and white matter hyperintensities (WMHs), is a frequent neuroimaging finding commonly seen on magnetic resonance imaging brain scans of elderly people with prevalence ranging from 50% to 100%. Although it remains asymptomatic, LA is not considered to be benign, and it is showed to be related to a host of poor clinical outcomes and increases the risk of disability, dementia, depression, stroke, and the overall morbidity and mortality. Pathologically, LA is characterized by loss of myelin and axons, patchy demyelination, and denudation of ependyma in regions of WMH. Age and hypertension are the most importantly established risk factors for LA. However, the precise pathogenic mechanisms remain unclear. Together with the previous findings, our recent genetic results strongly supported that LA is associated with immune response and neuroinflammation. Therefore, we confidently hypothesized that LA was not only a common neuroimaging phenomenon in the elderly but also an emerging neuroinflammatory disorder in the central nervous system. This article focusing on neuroimaging classification, genetics basis, and putative molecular mechanism introduced the basic knowledge and current status of LA and put forward some of our research ideas and results from our molecular genetics research, which may pave the way for deciphering the putative pathogenic mechanism, risk factor, epigenetic index, and its application in diagnostic agents or drug target for prevention and treatment. Thus, it could provide clinicians and researchers with a specific and modern overview of LA to enable the understanding of recent progress and future directions in this illness.
    Reviews in the neurosciences 03/2015; DOI:10.1515/revneuro-2014-0082 · 3.33 Impact Factor
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    • "The WMC increased the risk for stroke [8, 95, 148, 149] and death [149–151]. A recent meta-analysis revealed that stroke yielded a significant association of WMC with incident stroke (HR 3.5 (2.5–4.9), "
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    ABSTRACT: Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
    Journal of aging research 08/2011; 2011(8):617927. DOI:10.4061/2011/617927
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    ABSTRACT: Objective: We aim to determine the relationship between leukoaraiosis and carotid artery stenosis. Methods: Carotid-cerebral multislice computed tomography angiographies of 194 patients (mean age, 63.5 years) were retrospectively evaluated. Presence and severity of leukoaraiosis and carotid artery stenosis were compared to each other. Carotid artery stenosis was defined by the criteria of the North American Symptomatic Carotid Endarterectomy Trial; leukoaraiosis was evaluated based on the European Task Force on Age-Related White Matter Changes criteria. Results: The frequency of leukoaraiosis was 52%. The correlations between age and presence and severity of leukoaraiosis as well as the degree of carotid artery stenosis were significant. There was a significant relationship between the presence of leukoaraiosis and carotid artery stenosis; also, a positive correlation was found between the severity of the leukoaraiosis and the degree of carotid artery stenosis. Conclusions: Leukoaraiosis is more common among the elderly. Significant relationship between the severity of leukoaraiosis and the degree of carotid artery stenosis points out that leukoaraiosis may be an advanced stage of atherosclerosis.
    Journal of computer assisted tomography 05/2013; 37(3):327-332. DOI:10.1097/RCT.0b013e318284604e · 1.41 Impact Factor
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