on June 3, 2004
Published online before print June 3, 2004, doi: 10.1161/01.STR.0000132193.35955.69
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Submitted on December 17, 2003
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; and the Department of Radiology (N.B.), University of Pennsylvania, Philadelphia, Pa. * To whom correspondence should be addressed. 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 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 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.
Revised on April 21, 2004
Accepted on April 22, 2004
White Matter Hyperintensity on Cranial Magnetic Resonance Imaging. A Predictor of Stroke
Lewis H. Kuller MD, DrPH*;
2 was a predictor of risk for stroke, independent of other risk factors.5), compared with only 0.6% for participants with grades 0 to 1.
Key words: stroke • magnetic resonance imaging • white matter • infarcts, silent • hypertension • diabetes mellitus
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