Cerebral Microbleeds as Predictors of Mortality: The Framingham Heart Study.
BACKGROUND AND PURPOSE
Cerebral microbleeds (CMB) represent a common magnetic resonance imaging marker of cerebral small vessel disease, increasingly recognized as a subclinical marker of stroke and dementia risk. CMB detection may reflect the cumulative effect of vascular risk burden and be a marker of higher mortality. We investigated the relation of CMB to risk of death in community dwelling participants free of stroke and dementia.


METHODS
We evaluated 1963 Framingham Original and Offspring Cohort participants (mean age 67 years; 54% women) with available brain magnetic resonance imaging and mortality data. Using Cox proportional hazards models, we related CMB to all-cause, cardiovascular, and stroke-related mortality.


RESULTS
Participants with CMB (8.9%) had higher prevalence of cardiovascular risk factors and use of preventive medications. During a mean follow-up of 7.2±2.6 years, we observed 296 deaths. In age- and sex-adjusted analysis, CMB were associated with increased all-cause mortality (hazards ratio, 1.39; 95% confidence interval 1.03-1.88), a relation that was no longer significant after adjustment for cardiovascular risk and preventive medication use (hazards ratio, 1.15; 95% confidence interval, 0.82-1.63).


CONCLUSIONS
CMBs may represent the deleterious effect of cardiovascular risk factors in the cerebral vasculature. Although their presence was associated with increased all-cause mortality, the effect was no longer present after accounting for vascular risk factors and preventive treatment use. Further studies are required to clarify the role of cardiovascular preventive therapies for prevention of mortality in persons with incidental detection of CMB.
['Romero|José R|JR|', 'Preis|Sarah R|SR|', 'Beiser|Alexa|A|', 'Himali|Jayandra J|JJ|', 'Shoamanesh|Ashkan|A|', 'Wolf|Philip A|PA|', 'Kase|Carlos S|CS|', 'Vasan|Ramachandran S|RS|', 'DeCarli|Charles|C|', 'Seshadri|Sudha|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002543:Cerebral Hemorrhage D059345:Cerebral Small Vessel Diseases D005260:Female D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D015995:Prevalence D012307:Risk Factors D020521:Stroke
cerebral microbleed cerebral small vessel disease community epidemiology