title: Population-Based Study of Cerebral Microbleeds in Stroke-Free Older Adults Living in Rural Ecuador: The Atahualpa Project.
abstract: OBJECTIVE
  Prevalence of cerebral microbleeds (CMB) in white and Asian populations range from 4% to 15%. However, there is no information from indigenous Latin American people. We aimed to assess prevalence and cerebrovascular correlates of CMB in stroke-free older adults living in rural Ecuador.
  
  
  METHODS
  Of 311 Atahualpa residents aged ≥60 years identified during a door-to-door survey, 258 (83%) underwent brain magnetic resonance imaging. Twenty-one were further excluded for a diagnosis of overt stroke. Using multivariate logistic regression models, adjusted for demographics and cardiovascular risk factors, we evaluated whether CMB were independently associated with silent strokes, white matter hyperintensities, and global cortical atrophy.
  
  
  RESULTS
  Twenty-six (11%) of 237 participants had CMB, which were single in 54% of cases. CMB were deep in 11 patients, cortical in 9, and located both deep and cortical in 6. In univariate analyses, CMB were associated with age, systolic blood pressure, moderate-to-severe white matter hyperintensities, silent lacunar infarcts, and cortical atrophy. Mean (±SD) values for systolic blood pressure were 155±27 mm Hg in patients who had CMB versus 142±26 mm Hg in those who did not (P=0.017). In the adjusted models, moderate-to-severe white matter hyperintensities (P=0.009), silent lacunar infarcts (P=0.003), and global cortical atrophy (P=0.04) were independently associated with CMB.
  
  
  CONCLUSIONS
  Prevalence of CMB in stroke-free older adults living in Atahualpa is comparable with those reported from other ethnic groups. There is a strong relationship between CMB and increased age, high systolic blood pressure, silent markers of cerebral small vessel disease, and cortical atrophy.
authors.affiliation: From the Internal Medicine Department, Louis A. Weiss Memorial Hospital, Chicago, IL (V.J.D.B.); Community Center, The Atahualpa Project, Atahualpa, Ecuador (M.Z.); Gastroenterology Department, University of Vanderbilt, Nashville, TN (R.M.M.); and School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador (O.H.D.B.).
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Del Brutto
authors.affiliation: From the Internal Medicine Department, Louis A. Weiss Memorial Hospital, Chicago, IL (V.J.D.B.); Community Center, The Atahualpa Project, Atahualpa, Ecuador (M.Z.); Gastroenterology Department, University of Vanderbilt, Nashville, TN (R.M.M.); and School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador (O.H.D.B.).
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.affiliation: From the Internal Medicine Department, Louis A. Weiss Memorial Hospital, Chicago, IL (V.J.D.B.); Community Center, The Atahualpa Project, Atahualpa, Ecuador (M.Z.); Gastroenterology Department, University of Vanderbilt, Nashville, TN (R.M.M.); and School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador (O.H.D.B.).
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: From the Internal Medicine Department, Louis A. Weiss Memorial Hospital, Chicago, IL (V.J.D.B.); Community Center, The Atahualpa Project, Atahualpa, Ecuador (M.Z.); Gastroenterology Department, University of Vanderbilt, Nashville, TN (R.M.M.); and School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador (O.H.D.B.). oscardelbrutto@hotmail.com.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000208:ethnology; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis* / Q000208:ethnology; D004484:Ecuador / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology
keywords: Ecuador; cerebral small vessel disease; ethnic groups; microbleed