title: Smoking and white matter hyperintensity progression: the ARIC-MRI Study.
abstract: OBJECTIVE
  Our objective was to examine the link between smoking and smoking history, including smoking intensity and cessation, overall and by race, in a biracial prospective cohort study.
  
  
  METHODS
  A subset of Atherosclerosis Risk in Communities Study participants (n = 972, 49% black) completed brain MRI scans twice (1993-1995 and 2004-2006). We defined white matter hyperintensity (WMH) progression as an increase of ≥2 points on the 9-point Cardiovascular Health Study scale across scans. Participants reported information on smoking behavior at the baseline MRI and at 2 prior study visits, approximately 3 and 6 years before baseline. We used adjusted logistic regression to evaluate the association between smoking variables and WMH progression in the total sample and separately by race (black and white).
  
  
  RESULTS
  We found WMH progression in 23% of participants (30% of black participants, 17% of white participants). Overall, being a current smoker 6 years before baseline was associated with WMH progression. In race-stratified analyses, we found adverse associations with smoking status at multiple time points and persistent smoking in white but not in black participants. However, we found no statistical support for effect modification by race for most of these analyses. Increasing pack-years of smoking was associated with greater risk of WMH progression, while time since quitting and age at smoking initiation were not associated with WMH progression, with little indication of differences in these associations by race.
  
  
  CONCLUSIONS
  Our findings concur with previous studies suggesting a relationship between smoking and WMH progression, and further demonstrate a dose-dependent association.
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson. melindacpower@gmail.com.
authors: Melinda C
authors: MC
authors: Power
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: Jennifer A
authors: JA
authors: Deal
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: A Richey
authors: AR
authors: Sharrett
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: Clifford R
authors: CR
authors: Jack
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: David
authors: D
authors: Knopman
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: Thomas H
authors: TH
authors: Mosley
authors: From the Department of Neurology, Johns Hopkins University School of Medicine (R.F.G.), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.C.P., J.A.D., A.R.S., R.F.G.), Baltimore, MD; Departments of Radiology (C.R.J.) and Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
authors: Rebecca F
authors: RF
authors: Gottesman
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000208:ethnology; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology*; D066127:White Matter / Q000473:pathology*; D044465:White People / Q000208:ethnology*
references: Stroke. 2005 Jan;36(1):56-61
references: 15569873
references: Epidemiology. 2012 Jan;23(1):129-31; discussion 132-7
references: 22157307
references: Stroke. 1996 Aug;27(8):1274-82
references: 8711786
references: J Am Geriatr Soc. 2010 Sep;58(9):1749-57
references: 20863334
references: Stroke. 2004 Aug;35(8):1857-61
references: 15218158
references: Lancet. 1993 May 15;341(8855):1232-7
references: 8098390
references: Am J Public Health. 2001 Feb;91(2):213-8
references: 11211629
references: Stroke. 2010 Jan;41(1):3-8
references: 19926835
references: Epidemiology. 2012 Jan;23(1):119-28
references: 21989136
references: Indian J Occup Environ Med. 2009 Aug;13(2):77-9
references: 20386623
references: Neurol Sci. 2012 Feb;33(1):45-51
references: 21562840
references: Stroke. 1996 Apr;27(4):645-9
references: 8614923
references: Stroke. 2008 Oct;39(10):2712-9
references: 18635849
references: Ann Neurol. 1992 Aug;32(2):177-83
references: 1510358
references: Neurology. 2009 Jul 14;73(2):120-5
references: 19597134
references: Neurology. 2004 Jul 13;63(1):139-44
references: 15249623
references: Stroke. 1994 Feb;25(2):318-27
references: 8303738
references: Stat Med. 2011 Feb 20;30(4):377-99
references: 21225900
references: Neurology. 2011 Aug 2;77(5):461-8
references: 21810696
references: Neurology. 2011 May 31;76(22):1879-85
references: 21543737
references: Radiology. 2005 Oct;237(1):251-7
references: 16126931
references: Lancet Neurol. 2013 Aug;12(8):822-38
references: 23867200
references: J Natl Med Assoc. 2008 Feb;100(2):200-7
references: 18300537
references: Neuroepidemiology. 1997;16(3):149-62
references: 9159770
references: BMJ. 2010;341:c3666
references: 20660506
references: Epidemiology. 2013 Nov;24(6):886-93
references: 24030502
references: Epidemiology. 2000 Sep;11(5):561-70
references: 10955409
references: Neurology. 2005 Jun 28;64(12):2056-62
references: 15985571