title: Brain volumes and risk of cardiovascular events and mortality. The SMART-MR study.
abstract: Brain atrophy is a strong predictor for cognitive decline and dementia, and these are, in turn, associated with increased mortality in the general population. Patients with cardiovascular disease have more brain atrophy and a higher morbidity and mortality. We investigated if brain volumes on magnetic resonance imaging were associated with the risk of cardiovascular events and mortality in patients with manifest arterial disease (n = 1215; mean age 58 years). Automated brain segmentation was used to quantify intracranial volume, and volumes of total brain, sulcal cerebrospinal fluid, and ventricles. After a median follow-up of 8.3 years, 184 patients died, 49 patients had an ischemic stroke, and 100 patients had an ischemic cardiac complication. Smaller relative brain volumes increased the risk of all-cause death (hazard ratio [HR] per standard deviation decrease in total brain volume: 1.58, 95% confidence interval [95% CI]: 1.33-1.88), vascular death (HR 1.69, 95% CI: 1.35-2.13), and ischemic stroke (HR 1.96, 95% CI: 1.43-2.69), independent of cardiovascular risk factors. These results suggest that brain volumes are an important determinant of poor outcome in patients with high cardiovascular risk.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Pieternella H
authors.initials: PH
authors.lastname: van der Veen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Majon
authors.initials: M
authors.lastname: Muller
authors.affiliation: Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Koen L
authors.initials: KL
authors.lastname: Vincken
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: m.geerlings@umcutrecht.nl.
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011379:Prognosis; D012306:Risk; D012307:Risk Factors; D020521:Stroke; D013997:Time Factors
keywords: Atherosclerosis; Brain imaging; Cardiovascular events; Cohort; Epidemiology; Mortality