Nazanin Sheibani1, Ka-Ho Wong1, Tanya N Turan1, Sharon D Yeatts2, Rebecca F Gottesman1, Shyam Prabhakaran1, Natalia S Rost1, Adam de Havenon3. 1. Departments of Neurology: University of Utah, MUSC, Johns Hopkins University, University of Chicago, MGH, 175 N. Medical Dr, Salt Lake City, UT 84132, USA. 2. Department of Public Health Sciences: MUSC, Salt Lake City, UT 84132, USA. 3. Departments of Neurology: University of Utah, MUSC, Johns Hopkins University, University of Chicago, MGH, 175 N. Medical Dr, Salt Lake City, UT 84132, USA. Electronic address: adam.dehavenon@hsc.utah.edu.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Malee S Fernando; Julie E Simpson; Fiona Matthews; Carol Brayne; Claire E Lewis; Robert Barber; Raj N Kalaria; Gill Forster; Filomena Esteves; Stephen B Wharton; Pamela J Shaw; John T O'Brien; Paul G Ince Journal: Stroke Date: 2006-04-20 Impact factor: 7.914
Authors: Jodi D Edwards; Joel Ramirez; Brandy L Callahan; Sheldon W Tobe; Paul Oh; Courtney Berezuk; Krista Lanctôt; Walter Swardfager; Sean Nestor; Alexander Kiss; Stephen Strother; Sandra E Black Journal: J Alzheimers Dis Date: 2017 Impact factor: 4.472
Authors: F-E de Leeuw; J C de Groot; M Oudkerk; J C M Witteman; A Hofman; J van Gijn; M M B Breteler Journal: Brain Date: 2002-04 Impact factor: 13.501
Authors: Lewis H Kuller; W T Longstreth; Alice M Arnold; Charles Bernick; R Nick Bryan; Norman J Beauchamp Journal: Stroke Date: 2004-06-03 Impact factor: 7.914
Authors: Tom Jeerakathil; Philip A Wolf; Alexa Beiser; Joseph Massaro; Sudha Seshadri; Ralph B D'Agostino; Charles DeCarli Journal: Stroke Date: 2004-06-24 Impact factor: 7.914
Authors: Ilya M Nasrallah; Nicholas M Pajewski; Alexander P Auchus; Gordon Chelune; Alfred K Cheung; Maryjo L Cleveland; Laura H Coker; Michael G Crowe; William C Cushman; Jeffrey A Cutler; Christos Davatzikos; Lisa Desiderio; Jimit Doshi; Guray Erus; Larry J Fine; Sarah A Gaussoin; Darrin Harris; Karen C Johnson; Paul L Kimmel; Manjula Kurella Tamura; Lenore J Launer; Alan J Lerner; Cora E Lewis; Jennifer Martindale-Adams; Claudia S Moy; Linda O Nichols; Suzanne Oparil; Paula K Ogrocki; Mahboob Rahman; Stephen R Rapp; David M Reboussin; Michael V Rocco; Bonnie C Sachs; Kaycee M Sink; Carolyn H Still; Mark A Supiano; Joni K Snyder; Virginia G Wadley; Jennifer Walker; Daniel E Weiner; Paul K Whelton; Valerie M Wilson; Nancy Woolard; Jackson T Wright; Clinton B Wright; Jeff D Williamson; R Nick Bryan Journal: JAMA Date: 2019-08-13 Impact factor: 56.272
Authors: Francesco Moroni; Enrico Ammirati; Maria A Rocca; Massimo Filippi; Marco Magnoni; Paolo G Camici Journal: Int J Cardiol Heart Vasc Date: 2018-05-14