title: White matter hyperintensities of presumed vascular origin: a population-based study in rural Ecuador (The Atahualpa Project).
abstract: BACKGROUND
  Cerebral small vessel disease is probably one of the most common pathogenetic mechanisms underlying stroke in Latin America. However, the importance of silent markers of small vessel disease, including white matter hyperintensities of presumed vascular origin, has not been assessed so far.
  
  
  OBJECTIVE
  The study aims to evaluate prevalence and correlates of white matter hyperintensities in community-dwelling elders living in Atahualpa (rural Ecuador).
  
  
  METHODS
  Atahualpa residents aged ≥ 60 years were identified during a door-to-door survey and invited to undergo brain magnetic resonance imaging for identification and grading white matter hyperintensities and other markers of small vessel disease. Using multivariate logistic regression models, we evaluated whether white matter hyperintensities is associated with demographics, cardiovascular health status, stroke, cerebral microbleeds, and cortical atrophy, after adjusting for the other variables.
  
  
  RESULTS
  Out of 258 enrolled persons (mean age, 70 ± 8 years; 59% women), 172 (67%) had white matter hyperintensities, which were moderate to severe in 63. Analyses showed significant associations of white matter hyperintensities presence and severity with age and cardiovascular health status, as well as with overt and silent strokes, and a trend for association with cerebral microbleeds and cortical atrophy.
  
  
  CONCLUSIONS
  Prevalence and correlates of white matter hyperintensities in elders living in rural Ecuador is almost comparable with that reported from industrialized nations, reinforcing the concept that the burden of small vessel disease is on the rise in underserved Latin American populations.
authors.affiliation: School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Department of Neurology, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Del Brutto
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.forename: Julio
authors.initials: J
authors.lastname: Lama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018672:Community Health Planning; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D014652:Vascular Diseases / Q000150:complications* / Q000453:epidemiology*
keywords: Ecuador; cardiovascular health status; cerebral small vessel disease; population-based study; silent stroke; white matter hyperintensities