title: Small Brain Lesions and Incident Stroke and Mortality: A Cohort Study.
abstract: BACKGROUND
  Although cerebral lesions 3 mm or larger on imaging are associated with incident stroke, lesions smaller than 3 mm are typically ignored.
  
  
  OBJECTIVE
  To examine stroke risks associated with subclinical brain lesions (<3 mm only, ≥3 mm only, and both sizes) and white matter hyperintensities (WMHs).
  
  
  METHODS
  Community cohort from the ARIC (Atherosclerosis Risk in Communities) Study.
  
  
  METHODS
  Two ARIC sites with magnetic resonance imaging (MRI) data from 1993 to 1995.
  
  
  METHODS
  1884 adults aged 50 to 73 years with MRI, no prior stroke, and average follow-up of 14.5 years.
  
  
  METHODS
  Lesions on MRI (by size), WMH score (scale of 0 to 9), incident stroke, all-cause mortality, and stroke-related mortality. Hazard ratios (HRs) were estimated with proportional hazards models.
  
  
  RESULTS
  Compared with no lesions, stroke risk tripled with lesions smaller than 3 mm only (HR, 3.47 [95% CI, 1.86 to 6.49]), doubled with lesions 3 mm or larger only (HR, 1.94 [CI, 1.22 to 3.07]), was 8-fold higher with lesions of both sizes (HR, 8.59 [CI, 4.69 to 15.73]), and doubled with a WMH score of at least 3 (HR, 2.14 [CI, 1.45 to 3.16]). Risk for stroke-related death tripled with lesions smaller than 3 mm only (HR, 3.05 [CI, 1.04 to 8.94]) and was 7 times higher with lesions of both sizes (HR, 6.97 [CI, 2.03 to 23.93]).
  
  
  CONCLUSIONS
  Few strokes (especially hemorrhagic) and few participants with lesions smaller than 3 mm only or lesions of both sizes.
  
  
  CONCLUSIONS
  Very small cerebrovascular lesions may be associated with increased risks for stroke and death; presence of lesions smaller than 3 mm and 3 mm or larger may result in a particularly striking risk increase. Larger studies are needed to confirm findings and provide more precise estimates.
  
  
  BACKGROUND
  National Heart, Lung, and Blood Institute.
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.forename: Bradley
authors.initials: B
authors.lastname: Deere
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.forename: Wanmei
authors.initials: W
authors.lastname: Wang
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Bezerra
authors.forename: Dean
authors.initials: D
authors.lastname: Shibata
authors.forename: Kenneth
authors.initials: K
authors.lastname: Butler
authors.forename: David
authors.initials: D
authors.lastname: Knopman
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D020520:Brain Infarction / Q000150:complications / Q000473:pathology*; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality