title: Progression of magnetic resonance imaging-defined brain vascular disease predicts vascular events in elderly: the Cardiovascular Health Study.
abstract: OBJECTIVE
  To determine whether progression of MRI-defined vascular disease predicts subsequent vascular events in the elderly.
  
  
  METHODS
  The Cardiovascular Health Study, a longitudinal cohort study of vascular disease in the elderly, allows us to address this question because its participants had 2 MRI scans≈5 years apart and have been followed for ≈9 years since the follow-up scan for incident vascular events.
  
  
  RESULTS
  Both MRI-defined incident infarcts and worsened white matter grade were significantly associated with heart failure, stroke, and death, but not transient ischemic attacks, angina, or myocardial infarction. Strongest associations occurred when both incident infarcts and worsened white matter grade were present for heart failure (hazard ratio, 1.79; 95% confidence interval, 1.18-2.73), stroke (hazard ratio, 2.58; 95% confidence interval, 1.53-4.36), death (hazard ratio, 1.69; 95% confidence interval, 1.28-2.24), and cardiovascular death (hazard ratio, 1.97; 95% confidence interval, 1.24-3.14).
  
  
  CONCLUSIONS
  Progression of MRI-defined vascular disease identifies elderly people at increased risk for subsequent heart failure, stroke, and death. Whether aggressive risk factor management would reduce risk is unknown.
authors.affiliation: Department of Neurology, University of Washington, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2420, USA. wl@uw.edu
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Alice M
authors.initials: AM
authors.lastname: Arnold
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Charles
authors.initials: C
authors.lastname: Bernick
authors.forename: David S
authors.initials: DS
authors.lastname: Lefkowitz
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Beauchamp
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000401:mortality / Q000473:pathology*