title: Silent cerebral infarction is associated with incident stroke and TIA independent of carotid intima-media thickness.
abstract: BACKGROUND
  Both silent cerebral infarction (SCI) and carotid intima-media thickness (IMT) are associated with future stroke. We evaluated whether SCI could be a predictor for incident stroke independent of carotid IMT in high-risk patients.
  
  
  METHODS
  We performed a prospective cohort study among 282 outpatients who had one or more atherosclerotic risk factors but without a history of cardiovascular disease. We conducted cranial MRI and measured carotid IMT at baseline, and then evaluated the risks of incident stroke and transient ischemic attacks (TIA) using Cox proportional hazards models.
  
  
  RESULTS
  SCI was present in 67 patients (23.7%) at baseline. During 4.1 years of follow-up, stroke and TIA occurred in 8 patients (2.8%). The incidence of stroke/TIA was 22.3 per 1,000 person-years in those with SCI compared with 2.2 per 1,000 person-years in those without SCI. Both SCI and carotid IMT at baseline were associated with incident stroke/TIA events after adjustment for age, sex, and traditional vascular risk factors. The predictive value of SCI remained significant even after adjustment for carotid IMT (HR 8.56; 1.72-42.55).
  
  
  CONCLUSIONS
  SCI, similar to carotid IMT, is an independent predictor of stroke and TIA in high-risk patients.
authors.affiliation: Department of Neurology, Osaka University Graduate School of Medicine, Suita. miwa@medone.med.osaka-u.ac.jp
authors.forename: Kaori
authors.initials: K
authors.lastname: Miwa
authors.forename: Taku
authors.initials: T
authors.lastname: Hoshi
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Hougaku
authors.forename: Makiko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Furukado
authors.forename: Yuko
authors.initials: Y
authors.lastname: Abe
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Saburo
authors.initials: S
authors.lastname: Sakoda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D017677:Age Distribution; D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016019:Survival Analysis; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*