(Stroke. 2000;31:425.)
© 2000 American Heart Association, Inc.
Original Contributions |
Aortic Atherosclerosis at Middle Age Predicts Cerebral White Matter Lesions in the Elderly
From the Department of Epidemiology and Biostatistics (F.-E. de L., J.C. de G., J.C.M.W., A.H., M.M.B.B.) and the Department of Radiology, Daniel den Hoed Cancer Clinic (M.O.), Erasmus University Medical School, Rotterdam, and the Department of Neurology, University Medical Center Utrecht (F.-E. de L., J.v.G.), Netherlands.
Correspondence to Dr Monique Breteler, Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail breteler{at}epib.fgg.eur.nl
Background and Purpose—MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions.
Methods—We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life.
Results—The presence of aortic atherosclerosis
during midlife was significantly associated with the presence of
periventricular white matter lesions 
20 years later
(adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks
increased linearly with the severity of aortic
atherosclerosis. No association was found between
midlife aortic atherosclerosis and subcortical white
matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or
between late-life aortic atherosclerosis and white
matter lesions.
Conclusions—The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.
Key Words: cerebrovascular disorders • atherosclerosis • leukoaraiosis • magnetic resonance imaging • white matter
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