title: Cerebral white matter lesions predict both ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.
abstract: BACKGROUND
  Cerebral white matter lesions (WML) are regarded as manifestations of small vessel disease, but have also been associated with large vessel atherosclerosis. We investigated whether WML have a predictive value for future ischemic events.
  
  
  RESULTS
  Two-hundred-thirty patients with proven atherosclerotic disease, recent ischemic stroke (IS, n=70), recent myocardial infarction (MI, n=71), or peripheral arterial disease (PAD, n=89) were included. The presence of periventricular lesions (PVL) and deep white matter lesions (DWML) on MRI at entry and ischemic events during follow-up were registered. During follow-up with a mean duration of 3.5+/-1.4 years 22 patients had a MI, 21 patients suffered an IS and 2 patients died suddenly. The frequency of ischemic events during follow-up was higher among patients with PVL than in those without PVL (IS: 18% versus 5%, p=0.001; MI: 15% versus 7%, p=0.03; any ischemic event: 36% versus 11%, p<0.001). DWML was associated only with the combined outcome any ischemic event (p=0.04). In multivariate regression analysis the presence of PVL was independently associated with IS (HR 3.2 (95%CI 1.3-8.4) and MI (HR 3.4 (95%CI 1.4-8.0)).
  
  
  CONCLUSIONS
  We observed an association between WML, especially PVL, and future ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. v.e.gerdes@amc.uva.nl
authors.forename: Victor E A
authors.initials: VE
authors.lastname: Gerdes
authors.forename: Vincent I H
authors.initials: VI
authors.lastname: Kwa
authors.forename: Hugo
authors.initials: H
authors.lastname: ten Cate
authors.forename: Dees P M
authors.initials: DP
authors.lastname: Brandjes
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Jan
authors.initials: J
authors.lastname: Stam
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed