Cerebral small vessel disease and risk of death, ischemic stroke, and cardiac complications in patients with atherosclerotic disease: the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study

Mandy M A Conijn, Raoul P Kloppenborg, Ale Algra, Willem P Th M Mali, L Jaap Kappelle, Koen L Vincken, Yolanda van der Graaf, Mirjam I Geerlings,

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND AND PURPOSE: Cerebral small vessel disease may be related to vascular and nonvascular pathology. We assessed whether lacunar infarcts and white matter lesions on MRI increased the risk of vascular and nonvascular death and future vascular events in patients with atherosclerotic disease.

METHODS: Brain MRI was performed in 1309 patients with atherosclerotic disease from the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study. Infarcts were scored visually and volumetric assessment of white matter lesion was performed. Patients were followed for a median of 4.5 years (range, 0.2 to 7.1 years) for death, ischemic stroke, and ischemic cardiac complications.

RESULTS: Cox regression models showed that presence of lacunar infarcts (n=229) increased the risk of vascular (hazard ratio, 2.6; 95% CI, 1.4 to 4.9) and nonvascular death (hazard ratio, 2.7; 95% CI, 1.3 to 5.3), adjusted for age, sex, vascular risk factors, nonlacunar infarcts, and white matter lesion. These risks were similar for patients with silent lacunar infarcts. White matter lesion volume (relative to total intracranial volume) increased the risk of vascular death (hazard ratio per milliliter increase, 1.03; 95% CI, 1.01 to 1.05) and white matter lesions in the upper quintile compared with lower quintiles increased risk of ischemic stroke (hazard ratio, 2.6; 95% CI, 1.3 to 4.9).

CONCLUSIONS: Cerebral small vessel disease, with or without a history of cerebrovascular disease, is associated with increased risk of death and ischemic stroke in patients with atherosclerotic disease.

Original languageEnglish
Pages (from-to)3105-3109
Number of pages5
JournalStroke
Volume42
Issue number11
DOIs
Publication statusPublished - Nov 2011

Keywords

  • Aged
  • Atherosclerosis
  • Brain Ischemia
  • Cerebral Small Vessel Diseases
  • Cerebrovascular Disorders
  • Cohort Studies
  • Female
  • Humans
  • Leukoencephalopathies
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Stroke
  • Stroke, Lacunar
  • Comparative Study
  • Journal Article
  • Research Support, Non-U.S. Gov't

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