From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.).
Stroke. 2018 Feb;49(2):304-311. doi: 10.1161/STROKEAHA.117.018943. Epub 2017 Dec 28.
Brain white matter hyperintensities (WMH) have been associated with increased risk of stroke, cognitive decline, and dementia. WMH can be a manifestation of small vessel disease, although the total microvascular contribution to multifactorial WMH pathophysiology remains unknown. We hypothesized a possible relationship between carotid intima-media thickness (cIMT), an ultrasound imaging marker of subclinical vascular disease, and brain WMH in a multiethnic, elderly stroke-free community-based cohort.
We evaluated the relationship between cIMT and WMH in the population-based Northern Manhattan Study, among individuals free of stroke. We used linear regression to examine the association of continuous measures of cIMT with quantitatively derived WMH volume, as a proportion of cranial volume, measured from fluid-attenuaded inversion recovery magnetic resonance imaging while adjusting for sociodemographics, lifestyle, and vascular risk factors.
In a cohort of 1229 participants (mean age, 71±9 years; 60% women, 15% White; 18% Black; 65% Hispanics), the mean cIMT was 0.71±0.08 mm and the median log-transformed WMH volume was 0.36 (interquartile range, 0.21-0.76). In a multivariable model, larger cIMT was significantly associated with greater WMH volume (β=0.046 per SD cIMT; =0.04). Age and race/ethnicity were significant modifiers ( for age, 0.02; and for race/ethnicity, 0.04). cIMT was associated with WMH volume in participants 70 years or older (β=0.088 per SD cIMT; =0.01) and among Hispanics (β=0.084 per SD cIMT; =0.003).
Larger cIMT was associated with greater burden of cerebral WM lesions independently of demographics and traditional vascular risk factors, particularly among elderly and Hispanic participants, who are at high risk for stroke and cognitive decline.
脑白质高信号（WMH）与中风、认知能力下降和痴呆的风险增加有关。WMH 可能是小血管疾病的表现，尽管总微血管对多因素 WMH 病理生理学的贡献仍不清楚。我们假设在一个多民族、无中风的老年社区为基础的队列中，颈动脉内膜中层厚度（cIMT）与脑 WMH 之间可能存在关系，cIMT 是亚临床血管疾病的超声影像学标志物。
我们评估了无中风的基于人群的北曼哈顿研究中 cIMT 与 WMH 之间的关系。我们使用线性回归来检验 cIMT 连续测量值与从液体衰减反转恢复磁共振成像中定量得出的 WMH 体积之间的关系，WMH 体积以颅内容积的比例表示，同时调整了社会人口统计学、生活方式和血管危险因素。
在一个由 1229 名参与者组成的队列中（平均年龄为 71±9 岁；60%为女性，15%为白人；18%为黑人；65%为西班牙裔），cIMT 的平均值为 0.71±0.08mm，log 转换后的 WMH 体积中位数为 0.36（四分位距为 0.21-0.76）。在多变量模型中，较大的 cIMT 与更大的 WMH 体积显著相关（每标准差 cIMT 增加 0.046；=0.04）。年龄和种族/民族是显著的调节剂（对于年龄，=0.02；对于种族/民族，=0.04）。在 70 岁或以上的参与者中，cIMT 与 WMH 体积相关（每标准差 cIMT 增加 0.088；=0.01），在西班牙裔中也存在相关性（每标准差 cIMT 增加 0.084；=0.003）。
较大的 cIMT 与脑白质病变的负担增加独立于人口统计学和传统血管危险因素相关，尤其是在老年人和西班牙裔中，这些人患中风和认知能力下降的风险较高。
