Determinants of white matter hyperintensity volume in patients with acute ischemic stroke.
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.
Rost
Natalia S
NS
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.
Rahman
Rosanna
R
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.
Sonni
Shruti
S
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Kanakis
Allison
A
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Butler
Christi
C
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Massasa
Efi
E
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Cloonan
Lisa
L
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Gilson
Aaron
A
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Delgado
Pilar
P
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Chang
Yuchiao
Y
Department of Medicine, Massachusetts General Hospital, Boston, MA.
Biffi
Alessandro
A
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.
Jimenez-Conde
Jordi
J
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.
Besanger
Angela
A
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Silva
Gisele
G
Department of Neurology, Massachusetts General Hospital, Boston, MA.
Smith
Eric E
EE
Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Rosand
Jonathan
J
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.
Furie
Karen L
KL
Department of Neurology, Massachusetts General Hospital, Boston, MA.
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*
D015415:Biomarkers; D006710:Homocysteine