London, United Kingdom 2013 2 Epidemiology of stroke 14:40 -14:50 Cerebral microbleeds and the risk of mortality in the general population. S. Akoudad1, M.A. Ikram2, P.J. Koudstaal3, A. Hofman4, A. van der Lugt5, M.W. Vernooij6 Dept. Epidemiology, Radiology, Neurology. Erasmus MC University Medical Center Rot-terdam, Rotterdam, THE NETHERLANDS1,Dept. Epidemiology, Radiology, Neurology. Erasmus MC University Medical Center Rotterdam, Rotterdam, THE NETHERLANDS2, Dept. Neurology. Erasmus MC University Medical Center Rotterdam, Rotterdam, THE NETHER-LANDS3, Dept. Epidemiology. Erasmus MC University Medical Center Rotterdam, Rotterdam, THE NETHERLANDS4, Dept. Radiology. Erasmus MC University Medical Center Rotterdam, Rotterdam, THE NETHERLANDS5, Dept. Epidemiology, Radiology. Erasmus MC University Medical Center Rotterdam, Rotterdam, THE NETHERLANDS6 Background: Presence of cerebral microbleeds indicates underlying vascular brain disease and has been implicated in lobar hemorrhages and dementia. All these conditions relate to shorter survival, but it remains unknown to what extent microbleeds increase the risk of mortality. We investigated the association of microbleeds with all-cause and cause-specific mortality in the general population. Methods We rated the brain MRI scans of 3979 Rotterdam Scan Study participants to determine presence, number, and location of microbleeds. Cox proportional hazard models, adjusted for age, sex, subcohort, vascular risk factors, and other MRI markers of cerebral vascular disease, were applied to quantify the association of microbleeds with mortality. Results: After a mean follow up of 5.2 (± 1.1) years, 172 (4.3%) persons had died. Presence of microbleeds, and particularly deep or infratentorial microbleeds, was significantly associated with an increased risk of all-cause mortality (sex-, age-, subcohort adjusted hazard ratio (HR) 2.27; CI 1.50- 3.45), independent of vascular risk factors (HR 1.87; 95% CI 1.20- 2.92). The presence of deep or infratentorial microbleeds strongly associated with the risk of cardiovascu-lar related mortality (HR 4.08; CI 1.78- 9.39). Mortality risk increased with increasing number of microbleeds. Conclusion: The presence of microbleeds, particularly those in deep or infratentorial regions and multiple microbleeds indicates an increased risk of mortality. Our data suggest that mi-crobleeds may mark severe underlying vascular pathology associated with poorer survival. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 139 Table 2. Vasomotor reactivity and the risk of mortality independent of stroke. All-cause mortality Cardiovascular mor-tality n/N n/N Vasomotor reactiv-ity* Quartile 1 124/423 1.50 (1.11; 2.05) 33/423 1.95 (1.01; 3.75) Quartile 2 101/424 1.41 (1.03; 1.93) 35/424 2.41 (1.27; 4.56) Quartile 3 85/424 1.19 (0.86; 1.65) 23/424 1.57 (0.79; 3.12) Quartile 4 64/424 1 (refer-ence) 13/424 1 (refer-ence) Per SD 374/1695 0.89 (0.81; 0.98) 104/1695 0.83 (0.70; 0.99) Values are hazard ratios with 95% confidence intervals. n: number of cases N: number of persons at risk Models are adjusted for age and sex. * Vasomotor reactivity was natural log transformed
Karger_ESC London_2013
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