Abstract 146: Cerebral Microbleeds: Prevalence and Risk Factors in the Framingham Study
Objective: To assess the prevalence of CMB in a middle-aged to elderly community-based cohort and explore the association of cardiovascular risk factors (CVRF) and medication use to CMB occurrence and location.
Background: CMB have been associated with increased risk of stroke and dementia. CVRF and some medications used for stroke prevention may increase the risk of CMB. We hypothesized that these associations would vary according to CMB location, since location is determined by underlying vascular pathology, lobar CMB due to CAA and deep CMB due to hypertensive vasculopathy.
Methods: 1,965 Framingham Original and Offspring Cohort participants (age [mean (SD)] 66.5±11.0years; 54% women) who attended a baseline examination between 1998 and 2008 and also had a brain MRI with T2*GRE sequences were included. We evaluated age- and sex-specific prevalence of CMB. Using linear and logistic regression models we related various CVRF, APOE status and stroke prevention medications to presence of any CMB and to risk of CMB stratified by brain location.
Results: CMB were observed in 8.8% (n=173) of participants. 63% had only lobar CMBs, 22% deep and 15% had CMBs in both locations. CMB prevalence increased with age (p<0.0001) and was higher in men (p<0.001). Hypertension (HTN), HTN treatment and statin use were overall predictors of CMB (p<0.05). APOE ε4 and statin use were the only predictors for lobar CMB (p<0.05). HTN, HTN treatment, antiplatelet use and statin use were associated with greater risk of deep CMB (p<0.05). Diabetes, smoking and serum lipid levels were not associated with CMB prevalence. Participants with mixed CMB (lobar/deep) showed a similar pattern of associations as persons with only deep CMB.
Conclusions: Our results support findings in older cohorts of higher CMB prevalence with age and in men, an association of HTN, HTN treatment, statins and antiplatelet agents with deep, and of APOE ε4 genotype and statins with lobar CMB. Although we observed an association of statin use with CMB neither total cholesterol, nor HDL level, was associated with CMB risk. These findings expand our understanding of CMB pathophysiology, and will be extended by exploring associations with other biomarkers (such as inflammatory markers) and incident CMB.
- © 2012 by American Heart Association, Inc.