Leukoaraiosis and ambulatory blood pressure load in a healthy elderly cohort study: the PROOF study.
BACKGROUND
Old age and hypertension are consistently reported to be the main risk factors of leukoaraiosis. The association between white matter lesions (WMLs) and other cardiovascular risk factors (CVRF) remains controversial. We evaluated the association between CVRF and WMLs in a cohort study and determined the blood pressure variables that could predict WML severity.


METHODS
830 subjects (65+/-1 years of age, 60% women) from the PROOF study, with a reliable ABPM and brain MRI, were included. The exclusion criteria included prior myocardial infarction, stroke, heart failure, atrial fibrillation, type 1 diabetes mellitus, and pacing. White matter changes on MRI were defined as hyperintensities >5mm on FLAIR images. We used the total degree of WML (range: 0-30) by adding the region-specific scores of both hemispheres.


RESULTS
Linear regression analyses demonstrated a significant relationship between total leukoaraiosis score and 24h systolic blood pressure (SBP), 24h diastolic BP, daytime SBP and DBP and nighttime SBP. No significant relationship was found between leukoaraiosis score and clinical SBP, clinical DBP, or nocturnal DIP. There was also no significant relationship between leukoaraiosis and other recognized cardiovascular risk factors. Based on a ROC curve analysis, we identified the optimal threshold separating high-risk WML patients for a mean 24h SBP above 123 mmHg (p<0.05).


CONCLUSIONS
Even moderate increases in 24h SBP promote arteriolar fragility of the cerebral white matter in a population aged 65. The prognostic implications of such abnormalities in asymptomatic and moderate cardiovascular risk populations remain to be evaluated.
Service de radiologie, CHU Nord, 42055 Saint-Étienne, France; Service de médecine nucléaire, CHU Nord, 42055 Saint-Étienne, France.
John
J
Avet
Service de Physiologie Clinique et de l'Exercice, Pôle NOL, CHU Nord, 42055 Saint-Étienne, France; EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon42023 Saint-Étienne, France.
Vincent
V
Pichot
Service de Physiologie Clinique et de l'Exercice, Pôle NOL, CHU Nord, 42055 Saint-Étienne, France; EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon42023 Saint-Étienne, France.
Jean-Claude
JC
Barthélémy
Service de neurologie, Pôle NOL, Université Jean Monnet, CHU Nord, 42055 Saint-Étienne, France; Inserm U1028, Central Integration of Pain Lab, Université Claude Bernard Lyon 1, France.
Bernard
B
Laurent
Service de Physiologie Clinique et de l'Exercice, Pôle NOL, CHU Nord, 42055 Saint-Étienne, France; EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon42023 Saint-Étienne, France.
Arnauld
A
Garcin
Service de Physiologie Clinique et de l'Exercice, Pôle NOL, CHU Nord, 42055 Saint-Étienne, France; EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon42023 Saint-Étienne, France.
Frédéric
F
Roche
Service de Physiologie Clinique et de l'Exercice, Pôle NOL, CHU Nord, 42055 Saint-Étienne, France; EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon42023 Saint-Étienne, France. Electronic address: sebastien.celle@univ-st-etienne.fr.
Sébastien
S
Celle
D000368:Aged; D000375:Aging / Q000473:pathology / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D049292:Leukoaraiosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index
Aging; Hypertension; Leukoaraiosis