Del Brutto Victor J, Mera Robertino, Recalde Bettsy Y, Rumbea Denisse A, Costa Aldo F, Del Brutto Oscar H
Department of Neurology, University of Miami Miller School of Medicine, Miami, Fl, USA.
Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA.
Eur Stroke J. 2021 Dec;6(4):412-419. doi: 10.1177/23969873211060803. Epub 2021 Nov 10.
Cerebral small vessel disease (SVD) predicts all-cause mortality in Eastern Asian and Caucasian populations. However, little is known about SVD impact in individuals of different races/ethnic groups. In this study, we sought to estimate the mortality risk according to the total SVD (tSVD) score in older adults of Amerindian ancestry.
Participants aged ≥60 years from the prospective population-based Atahualpa Project cohort underwent brain MRI between June 2012 and June 2017. The tSVD score was calculated based on the presence of moderate-to-severe white matter hyperintensities, enlarged perivascular spaces, one or more lacune, and one or more cerebral microbleed. We ascertained all-cause mortality during post-MRI follow-up. Poisson regression and Cox-proportional hazards models adjusted for demographics and cardiovascular risk were obtained to estimate mortality risk according to the tSVD score.
Analysis included 375 participants with available brain MRI and clinical data (mean age 69.0 ± 8.3 years, 56.3% women). The tSVD score was 0 point in 216 individuals (57.6%), 1 point in 71 (18.9%), 2 points in 53 (14.1%), and 3-4 points in 35 (9.3%). Increasing tSVD score was associated with advancing age, hypertension, low level of education, and physical inactivity. Using tSVD score of 0 as reference, a multivariate Poisson regression model showed an increased mortality for individuals with a tSVD score 3-4 points (IRR: 2.27; 95% CI: 1.20-4.28). Likewise, in the Cox-proportional model adjusted for demographics and cardiovascular risk, participants with a tSVD score 3-4 maintained a greater than two-fold mortality risk when compared to those with tSVD score of 0 points (HR: 2.32; 95% CI: 1.23-4.39).
High-burden SVD as determined by the tSVD score predicts mortality in community-dwelling older adults of Amerindian ancestry. Incidental diagnosis of covert SVD should prompt aggressive control of cardiovascular health.
脑小血管疾病（SVD）可预测东亚和白种人群的全因死亡率。然而，关于SVD对不同种族/族裔个体的影响知之甚少。在本研究中，我们试图根据美洲印第安人后裔老年人的总SVD（tSVD）评分来估计死亡风险。
2012年6月至2017年6月期间，对基于人群的前瞻性阿塔瓦尔帕项目队列中年龄≥60岁的参与者进行脑部MRI检查。tSVD评分是根据中度至重度白质高信号、血管周围间隙扩大、一个或多个腔隙以及一个或多个脑微出血的存在情况计算得出的。我们确定了MRI检查后的全因死亡率。采用泊松回归和经人口统计学及心血管风险调整的Cox比例风险模型，根据tSVD评分来估计死亡风险。
分析纳入了375名有可用脑部MRI和临床数据的参与者（平均年龄69.0±8.3岁，56.3%为女性）。216名个体（57.6%）的tSVD评分为0分，71名（18.9%）为1分，53名（14.1%）为2分，35名（9.3%）为3 - 4分。tSVD评分的增加与年龄增长、高血压、低教育水平和身体活动不足相关。以tSVD评分为0作为参照，多变量泊松回归模型显示，tSVD评分为3 - 4分的个体死亡率增加（发病率比：2.27；95%置信区间：1.20 - 4.28）。同样，在经人口统计学和心血管风险调整的Cox比例模型中，tSVD评分为3 - 4分的参与者与tSVD评分为0分的参与者相比，死亡风险高出两倍多（风险比：2.32；95%置信区间：1.23 - 4.39）。
由tSVD评分确定的高负担SVD可预测美洲印第安人后裔社区居住老年人的死亡率。隐匿性SVD的偶然诊断应促使积极控制心血管健康。
