title: Arterial stiffness and progression of structural brain changes: The SMART-MR study.
abstract: OBJECTIVE
  To examine the cross-sectional and prospective associations between arterial stiffness and structural brain changes within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study, a prospective cohort study among patients with manifest arterial disease.
  
  
  METHODS
  Distension measurements of the common carotid arteries and a brain MRI were performed in 526 patients (mean age 59 ± 10 years). After a mean follow-up of 4.1 years (range 3.6-5.8), brain MRI was repeated in 308 patients. Brain segmentation was used to quantify total brain volume, cortical gray matter volume, ventricular volume, and white matter lesion (WML) volume (relative to intracranial volume). Infarcts were rated visually.
  
  
  RESULTS
  Cross-sectional multivariable regression analyses showed that 1 SD decrease in carotid distension, indicating increased arterial stiffness, was associated with smaller relative total brain and cortical gray matter volumes (B = -0.24%, 95% confidence interval [CI] -0.44 to -0.04%, and B = -0.47%, 95% CI -0.75 to -0.19%), with larger WML volume (B = 0.09%, 95% CI -0.01 to 0.19%), and with higher risk of having nonlacunar (cortical or large subcortical) brain infarcts (relative risk = 1.44, 95% CI 1.14 to 1.81). However, our prospective findings showed that carotid distension was not significantly associated with progression of brain atrophy, WML volume, or brain infarcts.
  
  
  CONCLUSIONS
  In this population of patients with manifest arterial disease, stiffening of the carotid arteries was cross-sectionally associated with more brain atrophy, WML volume, and nonlacunar infarcts, but did not lead to changes in brain volumes or infarcts after 4 years.
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Hadassa M
authors.initials: HM
authors.lastname: Jochemsen
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Majon
authors.initials: M
authors.lastname: Muller
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Koen L
authors.initials: KL
authors.lastname: Vincken
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Willem P T M
authors.initials: WP
authors.lastname: Mali
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (H.M.J., M.M., M.L.B., Y.v.d.G., M.I.G.), Image Sciences Institute (K.L.V.), and Department of Radiology (W.P.T.M.M.), University Medical Center Utrecht; the Alzheimer Center & Department of Neurology (H.M.J., P.S.), Neuroscience Campus Amsterdam, VU University Medical Center; and the Department of Geriatrics/Internal Medicine (M.M.), Leids University Medical Center, Leiden, the Netherlands. m.geerlings@umcutrecht.nl.
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D017536:Carotid Artery, Common / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059289:Vascular Stiffness