The significance of combined lacunar brain infarctions and white matter hyperintensities, as well as their progression over time for stroke prediction remains to be studied. Thus, associations between the progression in combined microvascular brain disease measures and stroke risk were studied in the ARIC (Atherosclerosis Risk in Communities) study. Prospective analysis of 907 ARIC participants who underwent a brain MRI in 1993-1995, and a second time done from 2004 to 2006, were thereafter followed for stroke incidence through December 31, 2017.
The associations between stroke incidence, microvascular brain disease, and progression in the combined measures were studied with Cox proportional hazard models, adjusting for education level, age, race, sex, time from first to second MRI, smoking, hypertension, body mass index, coronary heart disease, and diabetes mellitus. At the second brain MRI, the combined measure’s distribution was:
- 37% WMH grade <2 and no lacune;
- 57% WMH grade ≥2 or lacune;
- 6% WMH grade ≥2 and lacune.
No progression in the combined measures was observed in 38% of participants; 57% showed mild progression, and 5% showed moderate progression. Sixty-four incident strokes occurred during the follow-up period. Compared with no change in the combined measure, the moderate progression of microvascular brain disease was significantly associated with a higher risk of stroke.
In conclusion, progression of microvascular brain disease, manifesting as both new lacunes and an increase in WMHs grade, is related to substantial growth in stroke’s long-term risk.
Ref: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030063
