Prevalence and Correlates of Silent Cerebral Infarcts in the Framingham Offspring Study

Department of Neurology, Boston University, Boston, MA 02118, USA.
Stroke (Impact Factor: 5.72). 06/2008; 39(11):2929-35. DOI: 10.1161/STROKEAHA.108.516575
Source: PubMed


Previous estimates of the prevalence of silent cerebral infarction (SCI) on MRI in community-based samples have varied between 5.8% and 17.7% depending on age, ethnicity, presence of comorbidities, and imaging techniques. We document the prevalence and risk factors associated with SCI at midlife in the community-based Framingham sample.
Our study sample comprised 2040 Framingham Offspring (53% female; mean age, 62+/-9 years) who attended the sixth examination (1996-1998), underwent volumetric brain MRI (1999-2005,) and were free of clinical stroke at MRI. We examined the age- and sex-specific prevalences and the clinical correlates of SCI using multivariable logistic regression models.
At least 1 SCI was present in 10.7% of participants; 84% had a single lesion. SCI was largely located in the basal ganglia (52%), other subcortical (35%) areas, and cortical areas (11%). Prevalent SCI was associated with the Framingham Stroke Risk Profile score (OR, 1.27; 95% CI, 1.10-1.46); stage I hypertension was determined by JNC-7 criteria (OR,1.56; CI,1.15-2.11), an elevated plasma homocysteine in the highest quartile (OR, 2.23; CI, 1.42-3.51), atrial fibrillation (OR, 2.16; CI, 1.07-4.40), carotid stenosis >25% (OR, 1.62; 1.13-2.34), and increased carotid intimal-medial thickness above the lowest quintile (OR, 1.65; CI, 1.22-2.24).
The prevalence and distribution of SCI in the Framingham Offspring are comparable to previous estimates. Risk factors previously associated with clinical stroke were also found to be associated with midlife SCI. Our results support current guidelines emphasizing early detection and treatment of stroke risk factors.

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Available from: Margaret Kelly-Hayes, Oct 06, 2015
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    • "Several in vivo neuroimaging studies support these hypothesized mechanisms (Bots et al. 1993; Dai et al. 2008; Muller et al. 2012; Poels et al. 2010; Vermeer et al. 2007). Individuals with greater exposure to vascular risk factors are at greater risk of clinically silent infarcts, identified on T1-and T2-weighted MRI (Das et al. 2008; Vermeer et al. 2007), as well as microhemorrhages visible on highly-sensitive T2*-weighted sequences such as susceptibility-weighted imaging (Cordonnier et al. 2007; Goos et al. 2010; Poels et al. 2010). Deficits in cerebral perfusion, measured using perfusion MRI with arterial spin labeling, have been demonstrated in elderly individuals possessing vascular risk factors, especially hypertension (Dai et al. 2008; Hajjar et al. 2010; Muller et al. 2012). "
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    ABSTRACT: For some researchers, the relationship between prevalent cardiovascular risk factors and late-life cognitive decline is not worthy of further study. It is already known that effective treatment of vascular risk factors lowers risk of such major outcomes as stroke and heart attack, the argument goes; thus, any new information about the relationship between vascular risk factors and another major outcome - late-life cognitive decline-- is unlikely to have an impact on clinical practice. The purpose of this review is to probe the logic of this argument by focusing on what is known, and what is not known, about the relationship between vascular risk factors and late-life cognitive decline. The unknowns are substantial: in particular, there is relatively little evidence that current vascular risk factor treatment protocols are adequate to prevent late-life cognitive decline or the clinically silent brain injury that precedes it. In addition, there is relatively little understanding of which factors lead to differential vulnerability or resilience to the effects of vascular risk factors on silent brain injury. Differential effects of different classes of treatments are similarly unclear. Finally, there is limited understanding of the impact of clinically-silent neurodegenerative disease processes on cerebrovascular processes. Further study of the relationships among vascular risk factors, brain injury, and late-life cognitive decline could have a major impact on development of new vascular therapies and on clinical management of vascular risk factors, and there are promising avenues for future research in this direction.
    Neuropsychology Review 08/2014; 24(3). DOI:10.1007/s11065-014-9264-7 · 4.59 Impact Factor
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    • "AF increases the risk of cardiovascular outcomes such as heart failure and stroke and has harmful effects on quality of life, functional status, and cognition [3]. AF is associated with a twofold higher risk of stroke [4], silent cerebral infarction [5], and impaired cognitive function and dementia [6]. Therefore, an understanding of factors associated with the development of AF through longitudinal studies is essential for the design of preventive strategies [2]. "
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    ABSTRACT: Background and aim: Atrial fibrillation (AF) is an important cardiovascular disease in the elderly. The association between hyperuricemia and AF is unclear. Therefore, we aimed to investigate the prospective relationship between uric acid and development of AF in a nationally representative cohort of elderly people. Methods and results: A total of 1485 elderly people (age ≥ 65 yrs) from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were without AF on "electrocardiography" at baseline. Incident AF events (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM: 427.31) were identified using data from the National Health Insurance Dataset. Hyperuricemia was defined as levels of uric acid >7.0 mg/dL in men and 6.0 mg/dL in women. A Cox proportional hazards model was used to evaluate the association between hyperuricemia and incident AF. The follow-up period was from 1999 to 2000 to 2008. During the follow-up period (median: 9.16 yrs), 90 AF events occurred (44 in men and 46 in women). Older age, elevated systolic blood pressure, being an ex-smoker, and high uric acid were positively associated with incident AF. Hyperuricemia was positively associated with incident AF in normotensive (age-adjusted hazard ratio (HR): 2.65 and 95% confidence intervals: 1.05-6.69), but not in (1.20:0.74-1.94) hypertensive individuals (systolic blood pressure ≥130 or diastolic blood pressure ≥85 or using hypertensive medicine). A significant association between hyperuricemia and AF (3.78; 1.24-11.59) remained after adjusting for other potential confounders among normotensive older persons. Conclusion: Hyperuricemia is associated with the development of AF in elderly people with normal blood pressure.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 05/2014; 24(9). DOI:10.1016/j.numecd.2014.03.012 · 3.32 Impact Factor
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    • "Approximately 60 % of strokes in men and women of all ages are attributable to hypertension [1]. Hypertension is associated with an increased likelihood of subclinical or silent stroke, which in turn has been linked to an elevated risk of vascular dementia and recurrent stroke [26–28]. In addition to mean BP elevation, there is mounting evidence that visit-to-visit variability in SBP is an independent risk factor for stroke [29–31]. "
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    ABSTRACT: The blood pressure J-curve discussion has been ongoing for more than 30 years, yet there are still questions in need of definitive answers. On one hand, existing antihypertensive therapy studies provide strong evidence for J-curve-shaped relationships between both diastolic and systolic blood pressure and primary outcomes in the general hypertensive patient population, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and the elderly. On the other hand, we have very limited data on the relationship between systolic and diastolic blood pressure and stroke prevention. Moreover, it seems that this outcome is more a case of "the lower the better." Further large, well-designed studies are necessary in order to clarify this issue, especially as existing available studies are observational, and randomized trials either did not have or lost statistical power and were thus inconclusive.
    Current Hypertension Reports 10/2013; 15(6). DOI:10.1007/s11906-013-0402-z · 3.44 Impact Factor
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