期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 5, 期 3, 页码 -出版社
WILEY-BLACKWELL
DOI: 10.1161/JAHA.115.002377
关键词
brain magnetic resonance imaging; carotid atherosclerosis; carotid intima-media thickness; cerebral microbleeds
资金
- Framingham Heart Study's National Heart, Lung, and Blood Institute [N01-HC-25195, HHSN268201500001I]
- National Institute of Neurological Disorders and Stroke [R01 NS17950]
- National Institute on Aging [R01 AG16495, AG08122, K23AG038444, 1 R03 AG048180-01A1]
- NIH [1RO1 HL64753, R01 HL076784, 1 R01 AG028321, P30 AG010129]
- NHLBI [HL67288, 2K24HL04334]
Background-Carotid atherosclerosis is associated with subclinical ischemic cerebrovascular disease, but its role in hemorrhage-prone small vessel disease-represented by cerebral microbleed (CMB)-is unclear, although vascular risk factors underlie both conditions. We hypothesized that persons with carotid atherosclerosis would have higher risk of CMB, particularly in deep regions. Methods and Results-We studied 1243 participants in the Framingham Offspring Study (aged 56.9 +/- 8.8 years; 53% women) with carotid ultrasound available on 2 occasions (1995-1998 and 2005-2008) prior to brain magnetic resonance imaging. Using multivariable logistic regression, we related baseline carotid stenosis, baseline intima-media thickness, and site-specific carotid intima-media thickness progression (at internal and common carotid locations) to the prevalence and location (lobar or deep plus mixed) of CMB. In addition, we assessed effect modification by lipid levels and use of statin and antithrombotic medications. Carotid stenosis >= 25% (a marker of cerebrovascular atherosclerosis) was associated with presence of CMB overall (Odds Ratio 2.20, 95% CI 1.10-4.40) and at deep and mixed locations (odds ratio 3.60, 95% CI 1.23-10.5). Baseline carotid intima-media thickness was not associated with CMB. Progression of common carotid artery intima-media thickness among persons on hypertension treatment was associated with lower risk of deep and mixed CMB (odds ratio per SD 0.41, 95% CI 0.18-0.96). Conclusions-Cumulative vascular risk factor exposure may increase the risk of CMB, especially in deep regions. The apparent paradoxical association of carotid intima-media thickness progression with lower risk of CMB may reflect benefits of intensive vascular risk factor treatment among persons with higher cardiovascular risk and deserves further investigation. If replicated, the results may have potential implications for assessment of preventive and therapeutic interventions for subclinical cerebral hemorrhage.
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