03194nas a2200469 4500008004100000022001400041245014600055210006900201260001300270300001400283490000700297520186100304653001602165653000902181653002802190653001902218653002402237653002402261653001102285653001502296653001102311653001702322653001402339653001802353653002502371653003102396653000902427653002402436653001902460653001702479653001702496653001802513100002102531700002002552700001802572700001702590700001702607700002002624700002002644700002402664856003602688 2017 eng d a1524-463600aBlood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults.0 aBlood Pressure and Heart Rate Measures Associated With Increased c2017 Aug a1579-15860 v373 a

OBJECTIVE: In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings.

APPROACH AND RESULTS: In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses.

CONCLUSIONS: Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.

10aAge Factors10aAged10aAntihypertensive Agents10aBlood Pressure10aCerebral Infarction10aDisease Progression10aFemale10aHeart Rate10aHumans10aHypertension10aIncidence10aLeukoaraiosis10aLongitudinal Studies10aMagnetic Resonance Imaging10aMale10aProspective Studies10aPulsatile Flow10aRisk Factors10aTime Factors10aUnited States1 aLeung, Lester, Y1 aBartz, Traci, M1 aRice, Kenneth1 aFloyd, James1 aPsaty, Bruce1 aGutierrez, Jose1 aLongstreth, W T1 aMukamal, Kenneth, J uhttps://chs-nhlbi.org/node/746602717nas a2200241 4500008004100000022001400041245012600055210006900181260001300250300001000263490000700273520196900280100001902249700002002268700002402288700002602312700002002338700002102358700001802379700002202397700002002419856003602439 2020 eng d a1524-462800aCholesterol Variability and Cranial Magnetic Resonance Imaging Findings in Older Adults: The Cardiovascular Health Study.0 aCholesterol Variability and Cranial Magnetic Resonance Imaging F c2020 Jan a69-740 v513 a

Background and Purpose- Serum cholesterol variability, independent of mean, has been associated with stroke, white matter hyperintensities on cranial magnetic resonance imaging (MRI), and other cardiovascular events. We sought to assess the relationship between total serum cholesterol (TC) variability and cranial MRI findings of subclinical or covert vascular brain injury in a longitudinal, population-based cohort study of older adults. Methods- In the Cardiovascular Health Study, we assessed associations between intraindividual TC mean, trend, and variability over ≈5 years with covert brain infarction (CBI) and white matter grade (WMG) on cranial MRI. Mean TC was calculated for each study participant from 4 annual TC measurements between 2 MRI scans. TC trend was calculated as the slope of the linear regression of the TC measurements, and TC variability was calculated as the SD of the residuals from the linear regression. We evaluated the association of intraindividual TC variability with incident CBI and worsening WMG between 2 MRI scans in primary analyses and with prevalent CBI number and WMG on the follow-up MRI scan in secondary analyses. Results- Among participants who were eligible for the study and free of clinical stroke before the follow-up MRI, 17.9% of 1098 had incident CBI, and 27.8% of 1351 had worsening WMG on the follow-up MRI. Mean, trend, and variability of TC were not associated with these outcomes. TC variability, independent of mean and trend, was significantly associated with the number of CBI (β=0.009 [95% CI, 0.003-0.016] =0.004; N=1604) and was associated with WMG (β, 0.009 [95% CI, -0.0002 to 0.019] =0.055; N=1602) on the follow-up MRI. Conclusions- Among older adults, TC variability was not associated with incident CBI or worsening WMG but was associated with the number of prevalent CBI on cranial MRI. More work is needed to validate and to clarify the mechanisms underlying such associations.

1 aKalani, Rizwan1 aBartz, Traci, M1 aSuchy-Dicey, Astrid1 aElkind, Mitchell, S V1 aPsaty, Bruce, M1 aLeung, Lester, Y1 aRice, Kenneth1 aTirschwell, David1 aLongstreth, W T uhttps://chs-nhlbi.org/node/8286