Sara Kaffashian1, Christophe Tzourio1, Yi-Cheng Zhu1, Bernard Mazoyer1, Stéphanie Debette2. 1. From INSERM U1219 (S.K., C.T., S.D.) and CNRS-CEA UMR 5296 (B.M.), University of Bordeaux, Bordeaux Cedex, France; Department of Neurology, Peking Union Medical College Hospital, Beijing, China (Y.-C.Z.); and Department of Neurology, Bordeaux University Hospital, Bordeaux Cedex, France (S.D.). 2. From INSERM U1219 (S.K., C.T., S.D.) and CNRS-CEA UMR 5296 (B.M.), University of Bordeaux, Bordeaux Cedex, France; Department of Neurology, Peking Union Medical College Hospital, Beijing, China (Y.-C.Z.); and Department of Neurology, Bordeaux University Hospital, Bordeaux Cedex, France (S.D.). Stephanie.debette@u-bordeaux.fr.
Abstract
BACKGROUND AND PURPOSE: We examined the association of white-matter hyperintensity (WMH) volume and covert brain infarcts, which are the 2 major magnetic resonance imaging markers of covert cerebrovascular disease in older adults, with long-term risk of ischemic stroke and intracerebral hemorrhage (ICH) in the general population. METHODS: Participants were 1731 individuals aged ≥65 years from the Three-City Dijon study. We studied the association of WMH volume and brain infarct, with incident ischemic stroke overall, and by subtype, and with incident ICH. RESULTS: High total, periventricular, and deep WMHs were associated with incident ICH. Extensive periventricular WMH volume was associated with increased risk of ischemic stroke (hazard ratio, 1.94; 95% confidence interval, 1.12-3.35), particularly cardioembolic stroke. Covert brain infarcts were associated with incident ICH but not with incident ischemic stroke or its subtypes. CONCLUSIONS: Although of ischemic nature, both WMH volume and covert brain infarcts portend a major risk of ICH. If confirmed in independent studies, these findings could have important implications for the clinical management of covert vascular brain lesions.
BACKGROUND AND PURPOSE: We examined the association of white-matter hyperintensity (WMH) volume and covert brain infarcts, which are the 2 major magnetic resonance imaging markers of covert cerebrovascular disease in older adults, with long-term risk of ischemic stroke and intracerebral hemorrhage (ICH) in the general population. METHODS:Participants were 1731 individuals aged ≥65 years from the Three-City Dijon study. We studied the association of WMH volume and brain infarct, with incident ischemic stroke overall, and by subtype, and with incident ICH. RESULTS: High total, periventricular, and deep WMHs were associated with incident ICH. Extensive periventricular WMH volume was associated with increased risk of ischemic stroke (hazard ratio, 1.94; 95% confidence interval, 1.12-3.35), particularly cardioembolic stroke. Covert brain infarcts were associated with incident ICH but not with incident ischemic stroke or its subtypes. CONCLUSIONS: Although of ischemic nature, both WMH volume and covert brain infarcts portend a major risk of ICH. If confirmed in independent studies, these findings could have important implications for the clinical management of covert vascular brain lesions.
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