Abstract 91: Small Perivascular Spaces as Vascular Risk Factors

Introduction: Small perivascular spaces (SPVS) are gaining momentum as imaging biomarkers of cerebrovascular health. Hypothesis: SPVS confer vascular risks and the coexistence of SPVS with lacunar infarcts (LI) heightens these risks. Methods: Stroke-free participants in the population-based Northern Manhattan Study were followed for incident stroke (ischemic and hemorrhagic), MI, all death, vascular death, and any vascular event. Lesions with diameter of 3 mm or less and absence of FLAIR rim were classified as SPVS on a semi-quantitative scale (range 0 to 28). We defined “high SPVS burden” as the upper quintile and compared the rate of vascular events in this group to individuals in the lower 4 quintiles combined. LI were defined as lesions greater than 3 mm with associated FLAIR rim, round shape, and typical location. Cox models were used to calculate risks of outcomes after adjusting for confounders. Results: This analysis includes 1208 NOMAS participants (40% male, 65% Hispanic; mean age 71 ± 9 years at time of MRI) followed a mean of 6 ± 2 years. SPVS were present in 91% of the sample (median SPVS scale score 5). Compared to participants with a lesser burden of SPVS, participants with a high SPVS burden had a higher incidence rate per 1000 person-years of death (48 vs 34), vascular death (20 vs 11), ischemic stroke (12 vs 7) and any vascular event (37 vs 24). After adjusting for demographics and vascular risk factors, participants with a high burden of SPVS had a higher risk of death (HR 1.35, 1.00-1.78), vascular death (HR 1.55, 0.96-2.51), any stroke (HR 1.53, 0.91-2.57), MI (HR 1.29, 0.69-2.41), and any vascular event (HR 1.50, 1.07-2.11). The presence of lacunar infarcts was an effect modifier such that those with LI and a high SPVS burden had a greater risk of vascular death (B=0.63, P=0.03), any stroke (B=0.72, P=0.03) and any vascular event (B=0.54, P=0.02) compared to those without LI. Conclusions: In this multi-ethnic, population-based study, participants with a high burden of SPVS had increased incidence rates of vascular events. Furthermore, the joint presence of SPVS and LI heighten the risk of vascular death, any stroke and any vascular event. The presence of SPVS may help select subjects for randomized trials to assess intervention strategies.

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Abstract P172: Attributable risks of hypertension and diabetes for stroke, myocardial infarction and vascular death in the Northern Manhattan Study

Circulation ◽

10.1161/circ.129.suppl_1.p172 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Joshua Willey ◽

Emily Khan ◽

Sandino Cespedes ◽

Yeseon P Moon ◽

Tatjana Rundek ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Disease Incidence ◽

Population Level ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Vascular Events ◽

Cox Models ◽

Vascular Death ◽

Race Ethnicity

Objective: To determine the attributable risks (AR) for vascular events (VE: stroke, myocardial infarction, and vascular death) due to hypertension and diabetes by race/ethnicity, sex and age. Background: Understanding the distribution of risk factors and their contribution to disease incidence is critical for effective allocation of resources for disease prevention. There is little data on the relative contribution of vascular risk factors among multiethnic elderly populations. Methods: The Northern Manhattan Study is a population-based prospective cohort study of incidence, risk factors, and outcomes in a multiethnic urban population. Multi-variable Cox models adjusted for socio-demographic and vascular risk factors were used to calculate hazard ratios, AR and 95% confidence intervals (95%CI) for (1) all stroke and (2) VE. Results: The cohort (n=3,298) had mean age 69.2+/-10 years with 63% women, 52% Hispanic, 73% hypertensive and 21% diabetics. There were 347 strokes and 835 VE during a median follow-up of 12 years. The AR due to hypertension was 30% (95%CI 13-48%) for stroke and 24% (95%CI 13-35%) for VE; AR due to diabetes was 19% (95%CI 12-27%) for stroke and 13% (95%CI 8-17%) for VE.The AR for stroke from hypertension differed by age and race-ethnicity (table), while for diabetes it only differed by age. For VE, the AR of hypertension and diabetes did not differ by age, sex, or race-ethnicity. Conclusions: On a population level diabetes and hypertension have important effects on the risk of VE across all socio-demographic groups. For stroke, these effects are more notable at age< 80. Our results may in part be driven by competing risks for other VE outcomes with stroke, or a differential impact of risk factors on stroke in younger individuals.

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Abstract 235: Predictors of functional decline over time in an urban population: The Northern Manhattan Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a235 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Mandip Dhamoon ◽

Yeseon P Moon ◽

Myunghee C Paik ◽

Palma Gervasi-Franklin ◽

Ralph L Sacco ◽

...

Keyword(s):

Risk Factors ◽

Functional Status ◽

Functional Decline ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Vascular Events ◽

Over Time

Background: There is limited data on predictors of long-term functional status in population samples, and even less about the effect of vascular risk factors on function. We hypothesized that functional status would decline over time, and that vascular risk factors would affect function and mediate functional decline. Methods: The Northern Manhattan Study contains a prospective, population-based study of 3298 stroke-free individuals > 40 years of age, followed for a median of 11 years for vascular events. The Barthel index (BI) was assessed annually and analyzed as a continuous variable on a 100-point scale. Generalized estimating equations models were adjusted for demographic, medical, and social risk factors assessed at baseline. Models were censored and uncensored for stroke and myocardial infarction (MI) occurring during follow-up. Secondarily, motor and non-motor domains of the BI were analyzed separately, and models were stratified by age. Results: Mean age (standard deviation) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% had diabetes, and 74% hypertension. Among 3298 participants, there were 33556 BI assessments. There was an annual decline of 1.02 BI points (p<0.0001). Predictors of change in BI over time included: age (−0.08 BI points per year; p<0.0001), Hispanic ethnicity (−0.22 per year, compared to white; p=0.016), female sex (−0.30 per year, compared to male; p<0.0001), diabetes (−0.38 per year, compared to non-diabetics; p=0.0002), and depression (−0.26 per year, compared to no depression; p=0.046). Results did not change when stroke and MI were censored. Magnitude and significance of predictors of BI were similar for motor and non-motor domains. The following had a different effect on change in BI in those above the median age (68 years), compared to those less than or equal to the median: age (−0.15 per year vs. −0.03; p for difference <0.0001), female compared to male sex (−0.43 per year vs. −0.15; p=0.049), and depression compared to no depression (−0.64 per year vs. −0.008, p=0.023). Conclusion: In this large, population-based, multi-ethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when the effect of vascular events was excluded by censoring. Vascular risk factors predicted functional decline even in the absence of clinical events. The impact of gender sex and depression was stronger amongst the elderly.

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Differing Pattern of Ambulatory Blood Pressure in Very Elderly Men Expresses Dynamics in Atherosclerotic Load in the Senescence

International Journal of Hypertension ◽

10.1155/2012/417291 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Arkadiusz Siennicki-Lantz ◽

Sölve Elmståhl

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Blood Pressure Measurement ◽

Ankle Brachial Index ◽

The Elderly ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Pressure Development

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM.Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP.Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

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Prevalence of stroke in Argentina: A door-to-door population-based study (EstEPA)

International Journal of Stroke ◽

10.1177/1747493020932769 ◽

2020 ◽

pp. 174749302093276 ◽

Cited By ~ 2

Author(s):

SF Ameriso ◽

MM Gomez-Schneider ◽

MA Hawkes ◽

VA Pujol-Lereis ◽

DE Dossi ◽

...

Keyword(s):

Risk Factors ◽

Latin American ◽

Neurological Status ◽

Population Based ◽

Vascular Risk Factors ◽

Stroke Survivors ◽

Vascular Risk ◽

Population Based Study ◽

Stroke Prevalence ◽

Obstructive Sleep

Background Stroke burden is highest and is still rising in low- and middle-income countries. Epidemiologic stroke data are lacking in many of these countries. Stroke prevalence in Argentina has been unexplored for almost three decades. Aim This population-based study aims to determine prevalence of stroke in a representative sample of the Argentinean population. Methods We performed a door-to-door survey of randomly selected households in a city of 18,650 inhabitants. A structured questionnaire screening for potential stroke cases was used. All subjects screened positive were then evaluated by stroke neurologists for final adjudication. Data about stroke subtypes, neurological status, vascular risk factors, medications, and diagnostic tests were also collected. Results Among 2156 surveys, 294 were screened positive for a possible stroke. After neurological evaluation, there were 41 confirmed cases. The adjusted stroke prevalence was 1,974/100,000 inhabitants older than 40 years, and it was higher in men than in women (26.3‰ vs 13.2‰, p<0.01). Prevalence of ischemic stroke, intracranial hemorrhage, and transient ischemic attack were 15.8‰, 2.93‰, and 2.93‰, respectively. The most prevalent vascular risk factors in stroke survivors were hypertension, obstructive sleep apnea, and dyslipidemia. Conclusion Approximately 2 in every 100 subjects older than 40 years in this population are stroke survivors. Stroke prevalence in Argentina has remained stable over the last 30 years; it is higher than in most Latin American countries and similar to western populations.

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Mild cognitive impairment: Incidence and vascular risk factors in a population-based cohort

Neurology ◽

10.1212/wnl.0b013e318295d776 ◽

2013 ◽

Vol 80 (23) ◽

pp. 2112-2120 ◽

Cited By ~ 71

Author(s):

M. Ganguli ◽

B. Fu ◽

B. E. Snitz ◽

T. F. Hughes ◽

C.-C. H. Chang

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk

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Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316724 ◽

2018 ◽

Vol 89 (6) ◽

pp. 651-656 ◽

Cited By ~ 8

Author(s):

Joan Jiménez-Balado ◽

Iolanda Riba-Llena ◽

Edurne Garde ◽

Marta Valor ◽

Belen Gutiérrez ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Rating Scale ◽

Brain Mri ◽

Treatment Compliance ◽

Vascular Risk Factors ◽

Study Cohort ◽

Perivascular Spaces ◽

Vascular Risk ◽

Verbal Reasoning

ObjectivesThe clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI).MethodsData were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50–70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function.Results723 patients were included; the median age was 64 (59–67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=−0.021, 95% CI −0.038 to −0.003). No association was found between H-EPVS and MCI.ConclusionsH-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.

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Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

Current Treatment Options in Neurology ◽

10.1007/s11940-020-00648-y ◽

2020 ◽

Vol 22 (11) ◽

Author(s):

Adrian Scutelnic ◽

Mirjam R. Heldner

Keyword(s):

Risk Factors ◽

Vascular Disease ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Vascular Events ◽

Increased Risk ◽

Clinical Benefits ◽

Infection And Inflammation ◽

Unhealthy Diet ◽

New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

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