title: Brain Arterial Diameters as a Risk Factor for Vascular Events.
abstract: BACKGROUND
  Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events.
  
  
  RESULTS
  Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, called the brain arterial remodeling (BAR) score, was obtained by averaging the measured diameters within each individual. Individuals with a BAR score <-2 SDs were considered to have the smallest diameters, individuals with a BAR score >-2 and <2 SDs had average diameters, and individuals with a BAR score >2 SDs had the largest diameters. All vascular events were recorded prospectively after the brain magnetic resonance imaging. Spline curves and incidence rates were used to test our hypothesis. The association of the BAR score with death (P=0.001), vascular death (P=0.02), any vascular event (P=0.05), and myocardial infarction (P=0.10) was U-shaped except for ischemic stroke (P=0.74). Consequently, incidence rates for death, vascular death, myocardial infarction, and any vascular event were higher in individuals with the largest diameters, whereas individuals with the smallest diameters had a higher incidence of death, vascular death, any vascular event, and ischemic stroke compared with individuals with average diameters.
  
  
  CONCLUSIONS
  The risk of death, vascular death, and any vascular event increased at both extremes of brain arterial diameters. The pathophysiology linking brain arterial remodeling to systemic vascular events needs further research.
authors.affiliation: Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.).
authors.forename: Jose
authors.initials: J
authors.lastname: Gutierrez
authors.affiliation: Division of Biostatistics, Columbia University, New York, NY (K.C.).
authors.forename: Ken
authors.initials: K
authors.lastname: Cheung
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.).
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bagci
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.).
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, Miami, FL (A.B., N.A.).
authors.forename: Noam
authors.initials: N
authors.lastname: Alperin
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.).
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL (T.R., R.L.S., C.B.W.) Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL (C.B.W.) Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL (C.B.W.).
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
authors.affiliation: Department of Neurology, Columbia University, New YorkNY (J.G., M.V.E.) Department of Epidemiology, Columbia University, New York, NY (M.V.E.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D066253:Vascular Remodeling
keywords: brain arterial remodeling; stroke; vascular death; vascular disease