title: Cerebral Microbleeds Are Associated With an Increased Risk of Stroke: The Rotterdam Study.
abstract: BACKGROUND
  Cerebral microbleeds are highly prevalent in people with clinically manifest cerebrovascular disease and have been shown to increase the risk of stroke recurrence. Microbleeds are also frequently found in healthy elderly, a population in which the clinical implication of microbleeds is unknown.
  
  
  RESULTS
  In the population-based Rotterdam Study, the presence, number, and location of microbleeds were assessed at baseline on brain MRI of 4759 participants aged ≥45 years. Participants were followed for incident stroke throughout the study period (2005-2013). We used Cox proportional hazards to investigate if people with microbleeds were at increased risk of stroke in comparison with those without microbleeds, adjusting for demographic, genetic, and cardiovascular risk, and cerebrovascular imaging markers. Microbleed prevalence was 18.7% (median count 1 [1-111]). During mean follow-up of 4.9 years (standard deviation, 1.6) 93 strokes occurred (72 ischemic, 11 hemorrhagic, and 10 unspecified). Microbleed presence was associated with an increased risk of all strokes (hazard ratio, 1.93; 95% confidence interval, 1.25-2.99). The risk increased with greater microbleed count. In comparison with those without microbleeds, participants with microbleeds in locations suggestive of cerebral amyloid angiopathy (lobar with or without cerebellar microbleeds) were at increased risk of intracerebral hemorrhage (hazard ratio, 5.27; 95% confidence interval, 1.38-20.23). Microbleeds at other locations were associated with an increased risk of both ischemic stroke and intracerebral hemorrhage.
  
  
  CONCLUSIONS
  Microbleeds on MRI are associated with an increased risk of stroke in the general population. Our results strengthen the notion that microbleeds mark progression of cerebrovascular pathology and represent a precursor of stroke.
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Saloua
authors.initials: S
authors.lastname: Akoudad
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands. m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.affiliation: From Departments of Epidemiology (S.A., M.L.P.P., A.H., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), and Neurology (S.A., M.L.P.P., P.J.K., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors.forename: Meike W
authors.initials: MW
authors.lastname: Vernooij
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D016657:Cerebral Amyloid Angiopathy / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D059906:Neuroimaging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: cerebral microbleeds; epidemiology; hemorrhage; magnetic resonance imaging; stroke