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(Stroke. 2004;35:1821.)
© 2004 American Heart Association, Inc.

Original Contributions

White Matter Hyperintensity on Cranial Magnetic Resonance Imaging

A Predictor of Stroke

Lewis H. Kuller, MD, DrPH; W.T. Longstreth, Jr, MD, MPH; Alice M. Arnold, PhD; Charles Bernick, MD; R. Nick Bryan, MD, PhD Norman J. Beauchamp, Jr, MD, MHS for the Cardiovascular Health Study Collaborative Research Group

From the Department of Epidemiology (L.H.K.), University of Pittsburgh, Pittsburgh, Pa; the Departments of Epidemiology and Neurology (W.T.L.), Biostatistics (A.M.A.), and Radiology (N.J.B.), University of Washington, Seattle, Wash; the Division of Neurology (C.B.), University of Nevada, Las Vegas, Nev; and the Department of Radiology (R.N.B.), University of Pennsylvania, Philadelphia, Pa.

Correspondence to Dr Lewis H. Kuller, Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Room 550, Pittsburgh, PA 15213. E-mail KullerL{at}edc.pitt.edu

Background and Purpose— We have previously reported that several "silent" infarcts found on magnetic resonance imaging (MRI) were a risk factor for stroke. Several recent reports have shown that high white matter grade (WMG) and increasing WMG over time were risk factors for stroke. We tested the hypothesis that high WMG 2 was a predictor of risk for stroke, independent of other risk factors.

Methods— We examined the extent of white matter hyperintensity on cranial MRI of 3293 participants from the Cardiovascular Health Study (CHS). The degree of white matter hyperintensity was graded from least severe (grade=0) to most severe (grade=9). Participants were followed-up for an average of 7 years for the occurrence of a stroke. Clinical stroke diagnoses were based on hospital records reviewed by an adjudication committee expert in stroke diagnosis. During this period, 278 strokes occurred.

Results The relative risk of stroke increased significantly as the WMG increased. The risk of stroke was 2.8% per year for participants with high WMG (grades 5), compared with only 0.6% for participants with grades 0 to 1.

Conclusions The risk of stroke with high WMG is independent of traditional stroke risk factors and persists when controlling for MRI infarcts, another subclinical imaging marker of cerebrovascular disease. Assessment of white matter disease may be valuable in assessing future risk of stroke.

Key Words: stroke • magnetic resonance imaging • white matter • infarcts, silent • hypertension • diabetes mellitus

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