Association of Exhaled Carbon Monoxide with Stroke Incidence and Subclinical Vascular Brain Injury: Framingham Heart Study

Matthew Nayor, Danielle M. Enserro, Alexa S. Beiser, Susan Cheng, Charles DeCarli, Ramachandran S. Vasan, Sudha Seshadri

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Purpose-Exhaled carbon monoxide (CO) is associated with cardiometabolic traits, subclinical atherosclerosis, and cardiovascular disease, but its specific relations with stroke are unexplored. We related exhaled CO to magnetic resonance imaging measures of subclinical cerebrovascular disease cross-sectionally and to incident stroke/transient ischemic attack prospectively in the Framingham Offspring study. Methods-We measured exhaled CO in 3313 participants (age 59±10 years; 53% women), and brain magnetic resonance imaging was available in 1982 individuals (age 58±10 years; 54% women). Participants were analyzed according to tertiles of exhaled CO concentration. Results-In age-and sex-adjusted models, the highest tertile of exhaled CO was associated with lower total cerebral brain volumes, higher white-matter hyperintensity volumes, and greater prevalence of silent cerebral infarcts (P<0.05 for all). The results for total cerebral brain volume and white-matter hyperintensity volume were consistent after removing smokers from the sample, and the association with white-matter hyperintensity volume persisted after multivariable adjustment (P=0.04). In prospective analyses (mean follow-up 12.9 years), higher exhaled CO was associated with 67% (second tertile) and 97% (top tertile) increased incidence of stroke/transient ischemic attack relative to the first tertile that served as referent (P<0.01 for both). These results were consistent in nonsmokers and were partially attenuated upon adjustment for vascular risk factors. Conclusions-In this large, community-based sample of individuals without clinical stroke/transient ischemic attack at baseline, higher exhaled CO was associated with a greater burden of subclinical cerebrovascular disease cross-sectionally and with increased risk of stroke/transient ischemic attack prospectively. Further investigation is necessary to explore the biological mechanisms linking elevated CO with stroke.

Original languageEnglish (US)
Pages (from-to)383-389
Number of pages7
JournalStroke
Volume47
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Cerebrovascular Trauma
Carbon Monoxide
Stroke
Transient Ischemic Attack
Incidence
Cerebrovascular Disorders
Brain
Magnetic Resonance Imaging
Atherosclerosis
Cardiovascular Diseases

Keywords

  • Biomarkers
  • Carbon monoxide
  • Heme oxygenase (decyclizing)
  • Ischemic attack, transient
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Association of Exhaled Carbon Monoxide with Stroke Incidence and Subclinical Vascular Brain Injury : Framingham Heart Study. / Nayor, Matthew; Enserro, Danielle M.; Beiser, Alexa S.; Cheng, Susan; DeCarli, Charles; Vasan, Ramachandran S.; Seshadri, Sudha.

In: Stroke, Vol. 47, No. 2, 01.02.2016, p. 383-389.

Research output: Contribution to journalArticle

Nayor, Matthew ; Enserro, Danielle M. ; Beiser, Alexa S. ; Cheng, Susan ; DeCarli, Charles ; Vasan, Ramachandran S. ; Seshadri, Sudha. / Association of Exhaled Carbon Monoxide with Stroke Incidence and Subclinical Vascular Brain Injury : Framingham Heart Study. In: Stroke. 2016 ; Vol. 47, No. 2. pp. 383-389.
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abstract = "Background and Purpose-Exhaled carbon monoxide (CO) is associated with cardiometabolic traits, subclinical atherosclerosis, and cardiovascular disease, but its specific relations with stroke are unexplored. We related exhaled CO to magnetic resonance imaging measures of subclinical cerebrovascular disease cross-sectionally and to incident stroke/transient ischemic attack prospectively in the Framingham Offspring study. Methods-We measured exhaled CO in 3313 participants (age 59±10 years; 53{\%} women), and brain magnetic resonance imaging was available in 1982 individuals (age 58±10 years; 54{\%} women). Participants were analyzed according to tertiles of exhaled CO concentration. Results-In age-and sex-adjusted models, the highest tertile of exhaled CO was associated with lower total cerebral brain volumes, higher white-matter hyperintensity volumes, and greater prevalence of silent cerebral infarcts (P<0.05 for all). The results for total cerebral brain volume and white-matter hyperintensity volume were consistent after removing smokers from the sample, and the association with white-matter hyperintensity volume persisted after multivariable adjustment (P=0.04). In prospective analyses (mean follow-up 12.9 years), higher exhaled CO was associated with 67{\%} (second tertile) and 97{\%} (top tertile) increased incidence of stroke/transient ischemic attack relative to the first tertile that served as referent (P<0.01 for both). These results were consistent in nonsmokers and were partially attenuated upon adjustment for vascular risk factors. Conclusions-In this large, community-based sample of individuals without clinical stroke/transient ischemic attack at baseline, higher exhaled CO was associated with a greater burden of subclinical cerebrovascular disease cross-sectionally and with increased risk of stroke/transient ischemic attack prospectively. Further investigation is necessary to explore the biological mechanisms linking elevated CO with stroke.",
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AU - Nayor, Matthew

AU - Enserro, Danielle M.

AU - Beiser, Alexa S.

AU - Cheng, Susan

AU - DeCarli, Charles

AU - Vasan, Ramachandran S.

AU - Seshadri, Sudha

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AB - Background and Purpose-Exhaled carbon monoxide (CO) is associated with cardiometabolic traits, subclinical atherosclerosis, and cardiovascular disease, but its specific relations with stroke are unexplored. We related exhaled CO to magnetic resonance imaging measures of subclinical cerebrovascular disease cross-sectionally and to incident stroke/transient ischemic attack prospectively in the Framingham Offspring study. Methods-We measured exhaled CO in 3313 participants (age 59±10 years; 53% women), and brain magnetic resonance imaging was available in 1982 individuals (age 58±10 years; 54% women). Participants were analyzed according to tertiles of exhaled CO concentration. Results-In age-and sex-adjusted models, the highest tertile of exhaled CO was associated with lower total cerebral brain volumes, higher white-matter hyperintensity volumes, and greater prevalence of silent cerebral infarcts (P<0.05 for all). The results for total cerebral brain volume and white-matter hyperintensity volume were consistent after removing smokers from the sample, and the association with white-matter hyperintensity volume persisted after multivariable adjustment (P=0.04). In prospective analyses (mean follow-up 12.9 years), higher exhaled CO was associated with 67% (second tertile) and 97% (top tertile) increased incidence of stroke/transient ischemic attack relative to the first tertile that served as referent (P<0.01 for both). These results were consistent in nonsmokers and were partially attenuated upon adjustment for vascular risk factors. Conclusions-In this large, community-based sample of individuals without clinical stroke/transient ischemic attack at baseline, higher exhaled CO was associated with a greater burden of subclinical cerebrovascular disease cross-sectionally and with increased risk of stroke/transient ischemic attack prospectively. Further investigation is necessary to explore the biological mechanisms linking elevated CO with stroke.

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KW - Heme oxygenase (decyclizing)

KW - Ischemic attack, transient

KW - Stroke

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