Subclinical cerebrovascular disease increases the risk of incident stroke and mortality: The Northern Manhattan study

Clinton B. Wright, Chuanhui Dong, Enmanuel J. Perez, Janet De Rosa, Mitsuhiro Yoshita, Tatjana Rundek, Charles DeCarli, Jose Gutierrez, Mitchell S.V. Elkind, Ralph L. Sacco

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background--The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. Methods and Results--Stroke-free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non-Hispanic white, 17% non-Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1-1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0-1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1-4.4). White and black but not Hispanic participants had increased stroke risk (P < 0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1-3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3-3.8), lacunar (HR: 4.0; 95% CI, 1.3-12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0-12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1-1.7) and nonvascular (HR: 1.2; 95% CI, 1.0-1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4-5.8). Conclusions--In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.

Original languageEnglish (US)
Article numbere004069
JournalJournal of the American Heart Association
Volume6
Issue number9
DOIs
StatePublished - Sep 1 2017

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Cerebrovascular Disorders
Stroke
Mortality
Hispanic Americans
Blood Vessels
Brain
Proportional Hazards Models
Ethnic Groups

Keywords

  • Cerebrovascular disease/stroke
  • Epidemiology
  • Mortality
  • Stroke
  • White matter disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Subclinical cerebrovascular disease increases the risk of incident stroke and mortality : The Northern Manhattan study. / Wright, Clinton B.; Dong, Chuanhui; Perez, Enmanuel J.; De Rosa, Janet; Yoshita, Mitsuhiro; Rundek, Tatjana; DeCarli, Charles; Gutierrez, Jose; Elkind, Mitchell S.V.; Sacco, Ralph L.

In: Journal of the American Heart Association, Vol. 6, No. 9, e004069, 01.09.2017.

Research output: Contribution to journalArticle

Wright, CB, Dong, C, Perez, EJ, De Rosa, J, Yoshita, M, Rundek, T, DeCarli, C, Gutierrez, J, Elkind, MSV & Sacco, RL 2017, 'Subclinical cerebrovascular disease increases the risk of incident stroke and mortality: The Northern Manhattan study', Journal of the American Heart Association, vol. 6, no. 9, e004069. https://doi.org/10.1161/JAHA.116.004069
Wright, Clinton B. ; Dong, Chuanhui ; Perez, Enmanuel J. ; De Rosa, Janet ; Yoshita, Mitsuhiro ; Rundek, Tatjana ; DeCarli, Charles ; Gutierrez, Jose ; Elkind, Mitchell S.V. ; Sacco, Ralph L. / Subclinical cerebrovascular disease increases the risk of incident stroke and mortality : The Northern Manhattan study. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 9.
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title = "Subclinical cerebrovascular disease increases the risk of incident stroke and mortality: The Northern Manhattan study",
abstract = "Background--The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. Methods and Results--Stroke-free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60{\%} women, 15{\%} non-Hispanic white, 17{\%} non-Hispanic black, 68{\%} Hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6{\%}) had incident strokes and 244 died (19{\%}). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95{\%} CI, 1.1-1.9), ischemic stroke (HR: 1.3; 95{\%} CI, 1.0-1.8), and cryptogenic stroke (HR: 2.2; 95{\%} CI, 1.1-4.4). White and black but not Hispanic participants had increased stroke risk (P < 0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95{\%} CI, 1.1-3.3), ischemic stroke (HR: 2.2; 95{\%} CI, 1.3-3.8), lacunar (HR: 4.0; 95{\%} CI, 1.3-12.3), and cryptogenic stroke (HR: 3.6; 95{\%} CI, 1.0-12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95{\%} CI, 1.1-1.7) and nonvascular (HR: 1.2; 95{\%} CI, 1.0-1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95{\%} CI, 1.4-5.8). Conclusions--In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.",
keywords = "Cerebrovascular disease/stroke, Epidemiology, Mortality, Stroke, White matter disease",
author = "Wright, {Clinton B.} and Chuanhui Dong and Perez, {Enmanuel J.} and {De Rosa}, Janet and Mitsuhiro Yoshita and Tatjana Rundek and Charles DeCarli and Jose Gutierrez and Elkind, {Mitchell S.V.} and Sacco, {Ralph L.}",
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TY - JOUR

T1 - Subclinical cerebrovascular disease increases the risk of incident stroke and mortality

T2 - The Northern Manhattan study

AU - Wright, Clinton B.

AU - Dong, Chuanhui

AU - Perez, Enmanuel J.

AU - De Rosa, Janet

AU - Yoshita, Mitsuhiro

AU - Rundek, Tatjana

AU - DeCarli, Charles

AU - Gutierrez, Jose

AU - Elkind, Mitchell S.V.

AU - Sacco, Ralph L.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background--The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. Methods and Results--Stroke-free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non-Hispanic white, 17% non-Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1-1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0-1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1-4.4). White and black but not Hispanic participants had increased stroke risk (P < 0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1-3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3-3.8), lacunar (HR: 4.0; 95% CI, 1.3-12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0-12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1-1.7) and nonvascular (HR: 1.2; 95% CI, 1.0-1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4-5.8). Conclusions--In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.

AB - Background--The effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke, its ischemic subtypes, and mortality require further study in diverse samples. Methods and Results--Stroke-free participants in the Northern Manhattan Study underwent magnetic resonance imaging (N=1287; mean age 71±9 years, 60% women, 15% non-Hispanic white, 17% non-Hispanic black, 68% Hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). Cox models estimated proportional hazards of incident stroke of all types, ischemic stroke (and its subtypes), and mortality and stratified by race/ethnicity. In total 72 participants (6%) had incident strokes and 244 died (19%). In fully adjusted models, those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [HR]: 1.4; 95% CI, 1.1-1.9), ischemic stroke (HR: 1.3; 95% CI, 1.0-1.8), and cryptogenic stroke (HR: 2.2; 95% CI, 1.1-4.4). White and black but not Hispanic participants had increased stroke risk (P < 0.05 for heterogeneity for all and ischemic stroke). Those with subclinical brain infarct had greater risk for all stroke types (HR: 1.9; 95% CI, 1.1-3.3), ischemic stroke (HR: 2.2; 95% CI, 1.3-3.8), lacunar (HR: 4.0; 95% CI, 1.3-12.3), and cryptogenic stroke (HR: 3.6; 95% CI, 1.0-12.7), without significant heterogeneity across race/ethnic groups. Greater white matter hyperintensity volume increased both vascular (HR: 1.3; 95% CI, 1.1-1.7) and nonvascular (HR: 1.2; 95% CI, 1.0-1.5) mortality among Hispanic and white but not black participants (P=0.040 for heterogeneity). Subclinical brain infarct was associated with increased vascular mortality among Hispanic participants only (HR: 2.9; 95% CI, 1.4-5.8). Conclusions--In this urban US sample, subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type.

KW - Cerebrovascular disease/stroke

KW - Epidemiology

KW - Mortality

KW - Stroke

KW - White matter disease

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