title: Cerebral microbleeds are predictive of mortality in the elderly.
abstract: OBJECTIVE
  To investigate the prognostic value of cerebral microbleeds (CMB) regarding overall, cardiovascular-related, and stroke-related mortality and to investigate possible differences based on a cerebral amyloid angiopathy-type and nonlobar distribution of microbleeds.
  
  
  METHODS
  We included 435 subjects who were participants from the nested MRI substudy of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cox proportional hazard models were applied to estimate the risk of overall, cardiovascular-related, and stroke-related death associated with microbleeds in general and microbleeds with a lobar distribution suggestive of the presence of cerebral amyloid angiopathy. The corresponding Kaplan-Meier survival curves were calculated.
  
  
  RESULTS
  Subjects with >1 CMB had a 6-fold risk of stroke-related death compared to subjects without CMB (hazard ratio, 5.97; 95% CI, 1.60-22.26; P=0.01). The diagnosis of nonlobar microbleeds was associated with >2-fold risk of cardiovascular death compared to subjects without microbleeds (hazard ratio, 2.67; 95% CI, 1.23-5.81; P=0.01). Subjects with probable cerebral amyloid angiopathy-type microbleeds had >7-fold risk of stroke-related death compared to subjects without CMB (hazard ratio, 7.20; 95% CI, 1.44-36.10; P=0.02).
  
  
  CONCLUSIONS
  This is the first study investigating the association between microbleeds and risk of overall, cardiovascular-related, and stroke-related mortality in an elderly population. Our findings indicate that the diagnosis of microbleeds is potentially of clinical relevance. Larger studies are needed to expand our observations and to address potential clinical implications and cost-benefits of such a policy.
authors.affiliation: Department of Radiology, C2-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. i.altmann-schneider@lumc.nl
authors.forename: Irmhild
authors.initials: I
authors.lastname: Altmann-Schneider
authors.forename: Stella
authors.initials: S
authors.lastname: Trompet
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.forename: Adriaan C G M
authors.initials: AC
authors.lastname: van Es
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: Jeroen
authors.initials: J
authors.lastname: van der Grond
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors