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Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study

BACKGROUND: The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. METHODS AND RESULTS: Stroke‐free participants in the Northern Manhattan Study underwent magnetic...

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Autores principales: Wright, Clinton B., Dong, Chuanhui, Perez, Enmanuel J., De Rosa, Janet, Yoshita, Mitsuhiro, Rundek, Tatjana, DeCarli, Charles, Gutierrez, Jose, Elkind, Mitchell S. V., Sacco, Ralph L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634244/
https://www.ncbi.nlm.nih.gov/pubmed/28847914
http://dx.doi.org/10.1161/JAHA.116.004069
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author Wright, Clinton B.
Dong, Chuanhui
Perez, Enmanuel J.
De Rosa, Janet
Yoshita, Mitsuhiro
Rundek, Tatjana
DeCarli, Charles
Gutierrez, Jose
Elkind, Mitchell S. V.
Sacco, Ralph L.
author_facet Wright, Clinton B.
Dong, Chuanhui
Perez, Enmanuel J.
De Rosa, Janet
Yoshita, Mitsuhiro
Rundek, Tatjana
DeCarli, Charles
Gutierrez, Jose
Elkind, Mitchell S. V.
Sacco, Ralph L.
author_sort Wright, Clinton B.
collection PubMed
description BACKGROUND: The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. METHODS AND RESULTS: Stroke‐free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non‐Hispanic white, 17% non‐Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6–9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1–1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0–1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1–4.4). White and black but not Hispanic participants had increased stroke risk (P<0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1–3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3–3.8), lacunar (HR: 4.0; 95% CI, 1.3–12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0–12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1–1.7) and nonvascular (HR: 1.2; 95% CI, 1.0–1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4–5.8). CONCLUSIONS: In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.
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spelling pubmed-56342442017-10-18 Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study Wright, Clinton B. Dong, Chuanhui Perez, Enmanuel J. De Rosa, Janet Yoshita, Mitsuhiro Rundek, Tatjana DeCarli, Charles Gutierrez, Jose Elkind, Mitchell S. V. Sacco, Ralph L. J Am Heart Assoc Original Research BACKGROUND: The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. METHODS AND RESULTS: Stroke‐free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non‐Hispanic white, 17% non‐Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6–9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1–1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0–1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1–4.4). White and black but not Hispanic participants had increased stroke risk (P<0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1–3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3–3.8), lacunar (HR: 4.0; 95% CI, 1.3–12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0–12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1–1.7) and nonvascular (HR: 1.2; 95% CI, 1.0–1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4–5.8). CONCLUSIONS: In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type. John Wiley and Sons Inc. 2017-08-28 /pmc/articles/PMC5634244/ /pubmed/28847914 http://dx.doi.org/10.1161/JAHA.116.004069 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Wright, Clinton B.
Dong, Chuanhui
Perez, Enmanuel J.
De Rosa, Janet
Yoshita, Mitsuhiro
Rundek, Tatjana
DeCarli, Charles
Gutierrez, Jose
Elkind, Mitchell S. V.
Sacco, Ralph L.
Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title_full Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title_fullStr Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title_full_unstemmed Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title_short Subclinical Cerebrovascular Disease Increases the Risk of Incident Stroke and Mortality: The Northern Manhattan Study
title_sort subclinical cerebrovascular disease increases the risk of incident stroke and mortality: the northern manhattan study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634244/
https://www.ncbi.nlm.nih.gov/pubmed/28847914
http://dx.doi.org/10.1161/JAHA.116.004069
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