Koki Nakanishi1, Zhezhen Jin1, Shunichi Homma1, Mitchell S V Elkind1, Tatjana Rundek1, Seitetz C Lee1, Aylin Tugcu1, Mitsuhiro Yoshita1, Charles DeCarli1, Clinton B Wright1, Ralph L Sacco1, Marco R Di Tullio2. 1. From the Department of Medicine (K.N., S.H., S.C.L., A.T., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Department of Neurology, Hokuriku National Hospital, Nanto, Japan (M.Y.); and Department of Neurology, University of California at Davis (C.D.). 2. From the Department of Medicine (K.N., S.H., S.C.L., A.T., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., C.B.W., R.L.S.), Department of Public Health Sciences (T.R., C.B.W., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; Department of Neurology, Hokuriku National Hospital, Nanto, Japan (M.Y.); and Department of Neurology, University of California at Davis (C.D.). md42@cumc.columbia.edu.
Abstract
BACKGROUND AND PURPOSE: Although increased heart rate (HR) is a predictor of cardiovascular events and mortality, its possible association with subclinical cerebrovascular disease, which is prevalent in the elderly, has not been evaluated. This study aimed to investigate the association of daytime, nighttime, 24-hour HR, and HR variability with subclinical cerebrovascular disease in an elderly cohort without history of stroke. METHODS: The study cohort consisted of 680 participants (mean age, 73±7 years; 42% men) in sinus rhythm who underwent 24-hour ambulatory blood pressure and HR monitoring, 2-dimensional echocardiography, and brain magnetic resonance imaging as part of the CABL study (Cardiac Abnormalities and Brain Lesion). Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume (WMHV). The relationship of HR measures with the presence of silent brain infarct and upper quartile of log WMHV (log WMHV4) was analyzed. RESULTS: Presence of silent brain infarct was detected in 93 participants (13.7%); mean log WMHV was -0.92±0.93 (median, -1.05; min, -5.88; max, 1.74). Multivariate analysis showed that only nighttime HR (adjusted odds ratio, 1.29 per 10 bpm; 95% confidence interval, 1.03-1.61; P=0.026) was significantly associated with log WMHV4, independent of traditional cardiovascular risk factors, ambulatory systolic blood pressure, and echocardiographic parameters. No similar association was observed for daytime HR and HR variability. There was no significant association between all HR measures and silent brain infarct. CONCLUSIONS: In a predominantly elderly cohort, elevated nighttime HR was associated with WMHV, suggesting an independent role of HR in subclinical cerebrovascular disease.
BACKGROUND AND PURPOSE: Although increased heart rate (HR) is a predictor of cardiovascular events and mortality, its possible association with subclinical cerebrovascular disease, which is prevalent in the elderly, has not been evaluated. This study aimed to investigate the association of daytime, nighttime, 24-hour HR, and HR variability with subclinical cerebrovascular disease in an elderly cohort without history of stroke. METHODS: The study cohort consisted of 680 participants (mean age, 73±7 years; 42% men) in sinus rhythm who underwent 24-hour ambulatory blood pressure and HR monitoring, 2-dimensional echocardiography, and brain magnetic resonance imaging as part of the CABL study (Cardiac Abnormalities and Brain Lesion). Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume (WMHV). The relationship of HR measures with the presence of silent brain infarct and upper quartile of log WMHV (log WMHV4) was analyzed. RESULTS: Presence of silent brain infarct was detected in 93 participants (13.7%); mean log WMHV was -0.92±0.93 (median, -1.05; min, -5.88; max, 1.74). Multivariate analysis showed that only nighttime HR (adjusted odds ratio, 1.29 per 10 bpm; 95% confidence interval, 1.03-1.61; P=0.026) was significantly associated with log WMHV4, independent of traditional cardiovascular risk factors, ambulatory systolic blood pressure, and echocardiographic parameters. No similar association was observed for daytime HR and HR variability. There was no significant association between all HR measures and silent brain infarct. CONCLUSIONS: In a predominantly elderly cohort, elevated nighttime HR was associated with WMHV, suggesting an independent role of HR in subclinical cerebrovascular disease.
Authors: Stevo Julius; Paolo Palatini; Sverre E Kjeldsen; Alberto Zanchetti; Michael A Weber; Gordon T McInnes; Hans R Brunner; Giuseppe Mancia; M Anthony Schork; Tsushung A Hua; Bjoern Holzhauer; Dion Zappe; Silja Majahalme; Kenneth Jamerson; Nevres Koylan Journal: Am J Cardiol Date: 2011-12-09 Impact factor: 2.778
Authors: Shinichi Iwata; Zhezhen Jin; Joseph E Schwartz; Shunichi Homma; Mitchell S V Elkind; Tatjana Rundek; Ralph L Sacco; Marco R Di Tullio Journal: Atherosclerosis Date: 2012-01-10 Impact factor: 5.162
Authors: Sarah E Vermeer; Niels D Prins; Tom den Heijer; Albert Hofman; Peter J Koudstaal; Monique M B Breteler Journal: N Engl J Med Date: 2003-03-27 Impact factor: 91.245
Authors: Clinton B Wright; Myunghee C Paik; Truman R Brown; Sally P Stabler; Robert H Allen; Ralph L Sacco; Charles DeCarli Journal: Stroke Date: 2005-05-05 Impact factor: 7.914
Authors: Ralph L Sacco; Minesh Khatri; Tatjana Rundek; Qiang Xu; Hannah Gardener; Bernadette Boden-Albala; Marco R Di Tullio; Shunichi Homma; Mitchell S V Elkind; Myunghee C Paik Journal: J Am Coll Cardiol Date: 2009-12-08 Impact factor: 24.094
Authors: T Hisamatsu; K Miura; A Fujiyoshi; A Kunimura; T Ito; I Miyazawa; S Torii; A Shiino; K Nozaki; H Kanda; H Arima; T Ohkubo; H Ueshima Journal: Eur J Neurol Date: 2019-05-09 Impact factor: 6.089