title: Cerebral vasomotor reactivity and risk of mortality: the Rotterdam Study.
abstract: OBJECTIVE
  Accumulating vascular pathology in cerebral arteries leads to impaired cerebral vasomotor reactivity. In turn, impaired cerebral vasomotor reactivity is a risk factor for stroke in clinical populations. It remains unclear whether impaired cerebral vasomotor reactivity also reflects more systemic vascular damage. We investigated whether cerebral vasomotor reactivity is associated with the risk of mortality, focusing particularly on cardiovascular mortality independent from stroke.
  
  
  METHODS
  Between 1997 and 1999, 1695 participants from the Rotterdam Study underwent cerebral vasomotor reactivity measurements using transcranial Doppler. Follow-up was complete until January 1, 2011. We assessed the associations between cerebral vasomotor reactivity and mortality using Cox proportional hazards models, adjusting for age, sex, and blood pressure changes and subsequently for cardiovascular risk factors. We additionally censored for incident stroke.
  
  
  RESULTS
  During 17 004 person-years, 557 participants died, of whom 181 due to a cardiovascular cause. In the fully adjusted model, the hazard ratio per SD decrease in vasomotor reactivity was 1.10 (95% confidence interval [CI], 1.01-1.19) for all-cause mortality, 1.09 (95% CI, 0.94-1.26) for cardiovascular mortality, and 1.10 (95% CI, 0.99-1.21) for noncardiovascular mortality. These associations remained unchanged after censoring for incident stroke.
  
  
  CONCLUSIONS
  We found that lower cerebral vasomotor reactivity is associated with an increased risk of death. Incident stroke does not affect this association, suggesting that a lower cerebral vasomotor reactivity reflects a generally impaired vascular system.
authors.affiliation: From the Departments of Epidemiology (M.L.P.P., R.F.A.G.d.B., A.H., M.A.I.), Radiology (M.A.I.), and Neurology (M.L.P.P., R.F.A.G.d.B., P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Netherlands Consortium for Healthy Ageing, Leiden, the Netherlands (R.F.A.G.d.B., M.A.I.).
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.forename: Renée F A G
authors.initials: RF
authors.lastname: de Bruijn
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002536:Cerebral Arteries / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000401:mortality; D016019:Survival Analysis; D017585:Ultrasonography, Doppler, Transcranial; D014666:Vasomotor System / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: epidemiology; mortality; risk factors; stroke