Departments of Neurology: University of Utah, MUSC, Johns Hopkins University, University of Chicago, MGH, 175 N. Medical Dr, Salt Lake City, UT 84132, USA.
Department of Public Health Sciences: MUSC, Salt Lake City, UT 84132, USA.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105764. doi: 10.1016/j.jstrokecerebrovasdis.2021.105764. Epub 2021 Apr 3.
The Systolic Blood Pressure Intervention Trial (SPRINT) randomized patients to a goal systolic blood pressure (SBP) <120 mm Hg vs. <140 mm Hg. In a subset of participants, the SPRINT MIND ancillary study performed a baseline MRI and measured white matter hyperintensity volume (WMHv). In this secondary analysis, we evaluated the association between baseline WMHv and cardiovascular events during follow-up in the overall sample.
The primary outcome was the same as SPRINT, a composite of stroke, myocardial infarction, acute coronary syndrome, decompensated congestive heart failure, or cardiovascular death. We fit Cox models to the primary outcome and report adjusted hazard ratios (HR) for log-transformed WMHv and quartiles of WMHv.
Among 717 participants, the median (IQR) baseline WMHv was 1.62 (0.66-3.98) mL. The primary outcome occurred in 51/719 (7.1%). The median WMHv was higher in patients with the primary outcome (3.40 mL versus 1.56 mL, p < 0.001). In adjusted models, WMHv as a log-transformed continuous variable was associated with the primary outcome (HR 1.44, 95% CI 1.15-1.80). The highest quartile of WMHv, compared to the lowest, was also independently associated with the primary outcome (HR 3.21, 95% CI 1.27-8.13).
We found that the baseline volume of WMH was associated with future CVD risk in SPRINT MIND. Prospective clinical trials with larger sample sizes than the current study are needed to determine whether intensive BP lowering can reduce the high cardiovascular risk in patients with WMH.
收缩压干预试验（SPRINT）将患者随机分配至目标收缩压（SBP）<120mmHg 与<140mmHg。在部分参与者中，SPRINT MIND 辅助研究进行了基线 MRI 并测量了脑白质高信号体积（WMHv）。在这项二次分析中，我们评估了整个样本中基线 WMHv 与随访期间心血管事件之间的关联。
主要结局与 SPRINT 相同，为卒中、心肌梗死、急性冠脉综合征、失代偿性充血性心力衰竭或心血管死亡的复合结局。我们对主要结局拟合 Cox 模型，并报告 WMHv 对数变换值和 WMHv 四分位距的调整后危险比（HR）。
在 717 名参与者中，中位（IQR）基线 WMHv 为 1.62（0.66-3.98）mL。719 例患者中有 51 例（7.1%）发生主要结局。发生主要结局的患者中位 WMHv 更高（3.40mL 比 1.56mL，p<0.001）。在调整模型中，WMHv 作为对数连续变量与主要结局相关（HR 1.44，95%CI 1.15-1.80）。与最低四分位数相比，WMHv 的最高四分位数也与主要结局独立相关（HR 3.21，95%CI 1.27-8.13）。
我们发现基线 WMH 体积与 SPRINT MIND 中的未来 CVD 风险相关。需要进行样本量大于当前研究的前瞻性临床试验，以确定强化降压是否可以降低 WMH 患者的高心血管风险。
