title: Cerebral Microbleeds as Predictors of Mortality: The Framingham Heart Study.
abstract: Cerebral microbleeds (CMB) represent a common magnetic resonance imaging marker of cerebral small vessel disease, increasingly recognized as a subclinical marker of stroke and dementia risk. CMB detection may reflect the cumulative effect of vascular risk burden and be a marker of higher mortality. We investigated the relation of CMB to risk of death in community dwelling participants free of stroke and dementia.
  
  
  
  We evaluated 1963 Framingham Original and Offspring Cohort participants (mean age 67 years; 54% women) with available brain magnetic resonance imaging and mortality data. Using Cox proportional hazards models, we related CMB to all-cause, cardiovascular, and stroke-related mortality.
  
  
  
  Participants with CMB (8.9%) had higher prevalence of cardiovascular risk factors and use of preventive medications. During a mean follow-up of 7.2±2.6 years, we observed 296 deaths. In age- and sex-adjusted analysis, CMB were associated with increased all-cause mortality (hazards ratio, 1.39; 95% confidence interval 1.03-1.88), a relation that was no longer significant after adjustment for cardiovascular risk and preventive medication use (hazards ratio, 1.15; 95% confidence interval, 0.82-1.63).
  
  
  
  CMBs may represent the deleterious effect of cardiovascular risk factors in the cerebral vasculature. Although their presence was associated with increased all-cause mortality, the effect was no longer present after accounting for vascular risk factors and preventive treatment use. Further studies are required to clarify the role of cardiovascular preventive therapies for prevention of mortality in persons with incidental detection of CMB.
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.). joromero@bmc.org.
authors.forename: José R
authors.initials: JR
authors.lastname: Romero
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Preis
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Alexa
authors.initials: A
authors.lastname: Beiser
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Jayandra J
authors.initials: JJ
authors.lastname: Himali
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Ashkan
authors.initials: A
authors.lastname: Shoamanesh
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Philip A
authors.initials: PA
authors.lastname: Wolf
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Kase
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: From the Department of Neurology (J.R.R., A.B., P.A.W., C.S.K., S.S.), Section of Preventive Medicine (V.S.R.), and Department of Cardiology (V.S.R.), School of Medicine and Department of Biostatistics (S.R.P., A.B., J.J.H.), School of Public Health at Boston University, MA; Department of Medicine-Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of California-Davis (C.D.); and the NHLBI's Framingham Heart Study, Framingham, MA (J.R.R., S.R.P., A.B., J.J.H., P.A.W., C.S.K., V.S.R., S.S.).
authors.forename: Sudha
authors.initials: S
authors.lastname: Seshadri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology
keywords: cerebral microbleed; cerebral small vessel disease; community; epidemiology