title: Determinants of white matter hyperintensity volume in patients with acute ischemic stroke.
abstract: BACKGROUND
  White matter hyperintensity (WMH) is a common radiographic finding in the aging population and a potent risk factor for symptomatic cerebrovascular disease. It is unclear whether WMH represents a single or multiple biological processes. We sought to investigate the extent and determinants of WMH in patients with acute ischemic stroke (AIS).
  
  
  METHODS
  We retrospectively analyzed a prospectively enrolled hospital-based cohort of patients with AIS. WMH volume (WMHV) was measured using a previously published method with high interrater reliability based on a semiautomated image analysis program.
  
  
  RESULTS
  WMHV was measured in 523 consecutive patients with stroke (mean age 65.2 years, median WMHV 8.2 cm(3)). In univariate linear regression analyses, individuals who were older, had elevated homocysteine (HCY) level or systolic blood pressure, or history of hypertension (all P < .0001), decreased glomerular filtration rate (P < .0002), atrial fibrillation (P < .0008), or coronary artery disease (P < .03) had significantly greater WMHV. After multivariable adjustment, only age (P < .0001) and HCY levels greater than 9 mumol/L (P < .003) remained independently associated with WMHV.
  
  
  CONCLUSIONS
  In patients with AIS, risk factors for WMH severity do not appear to overlap with those previously reported for population-based cohorts. Only age and higher HCY levels were independently associated with more severe WMH in patients with stroke. This suggests that some of the processes underlying WMH burden accumulation in patients with stroke may differ from those in the general population and are not simply mediated by traditional vascular risk factors.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA. Electronic address: nrost@partners.org.
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Rahman
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Shruti
authors.initials: S
authors.lastname: Sonni
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Allison
authors.initials: A
authors.lastname: Kanakis
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Christi
authors.initials: C
authors.lastname: Butler
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Efi
authors.initials: E
authors.lastname: Massasa
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cloonan
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Gilson
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Pilar
authors.initials: P
authors.lastname: Delgado
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Biffi
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA.
authors.forename: Jordi
authors.initials: J
authors.lastname: Jimenez-Conde
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Angela
authors.initials: A
authors.lastname: Besanger
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Gisele
authors.initials: G
authors.lastname: Silva
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D015415:Biomarkers; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000150:complications; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*
chemical_list: D015415:Biomarkers; D006710:Homocysteine