Cardiometabolic Health and Longitudinal Progression of White Matter Hyperintensity: The Mayo Clinic Study of Aging

Eugene L. Scharf, Jonathan Graff-Radford, Scott A. Przybelski, Timothy G. Lesnick, Michelle M. Mielke, David S. Knopman, Gregory M. Preboske, Christopher G. Schwarz, Matthew L. Senjem, Jeffrey L. Gunter, Mary Machulda, Kejal Kantarci, Ronald C. Petersen, Clifford R. Jack, Prashanthi Vemuri

Research output: Contribution to journalArticle

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Abstract

Background and Purpose- White matter hyperintensity (WMH) burden is associated with stroke and cognitive decline. Risk factors associated with the longitudinal progression of WMH in the general population have not been systematically investigated. To investigate the primary midlife and current cardiometabolic risk factors associated with changes in WMH over time in a population cohort. Methods- This cohort study included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota with at least 2 consecutive WMH assessments on fluid-attenuated inversion recovery-magnetic resonance images (n=554, ≥60 years with midlife assessments) with relevant baseline laboratory measures of interest. Linear mixed model regression was used to determine the important components of cardiometabolic risk profile at baseline that were associated with future progression of WMH. These analyses were controlled for age and sex. Sensitivity analyses were conducted using stratification by sex. The main outcome measure was percent change in WMH normalized to total intracranial volume. Three sets of models were constructed to evaluate individual (1) midlife risk factors, (2) current risk factors including the presence of metabolic syndrome and its constituents, and (3) baseline measurements of continuous laboratory measures of cardiometabolic risk. Results- Age was the strongest predictor of progression in WMH (P<0.001). Baseline hypertension (P<0.001), midlife hypertension (P=0.003), and baseline fasting glucose in males (P=0.01) were predictive of WMH change. The presence of metabolic syndrome was not associated with progressive WMH. In sensitivity analyses, associations between hypertension and WMH progression were stronger in females. Baseline serum glucose was associated with increase in WMH but was not significant in females in the stratified analysis. Other continuous laboratory measures of vascular risk were not associated with progressive WMH. Conclusions- Midlife and current hypertension in all participants and fasting glucose in males were associated with quantitative changes in white matter. Prospective clinical studies should determine optimal blood pressure to reduce stroke and cognitive impairment during aging.

Original languageEnglish (US)
Pages (from-to)3037-3044
Number of pages8
JournalStroke
Volume50
Issue number11
DOIs
StatePublished - Nov 1 2019

Fingerprint

Health
Hypertension
Glucose
White Matter
Fasting
Stroke
Population
Blood Vessels
Linear Models
Cohort Studies
Magnetic Resonance Spectroscopy
Outcome Assessment (Health Care)
Prospective Studies
Blood Pressure
Serum

Keywords

  • blood pressure
  • hypertension
  • magnetic resonance imaging
  • metabolic syndrome
  • white matter

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Cardiometabolic Health and Longitudinal Progression of White Matter Hyperintensity : The Mayo Clinic Study of Aging. / Scharf, Eugene L.; Graff-Radford, Jonathan; Przybelski, Scott A.; Lesnick, Timothy G.; Mielke, Michelle M.; Knopman, David S.; Preboske, Gregory M.; Schwarz, Christopher G.; Senjem, Matthew L.; Gunter, Jeffrey L.; Machulda, Mary; Kantarci, Kejal; Petersen, Ronald C.; Jack, Clifford R.; Vemuri, Prashanthi.

In: Stroke, Vol. 50, No. 11, 01.11.2019, p. 3037-3044.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose- White matter hyperintensity (WMH) burden is associated with stroke and cognitive decline. Risk factors associated with the longitudinal progression of WMH in the general population have not been systematically investigated. To investigate the primary midlife and current cardiometabolic risk factors associated with changes in WMH over time in a population cohort. Methods- This cohort study included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota with at least 2 consecutive WMH assessments on fluid-attenuated inversion recovery-magnetic resonance images (n=554, ≥60 years with midlife assessments) with relevant baseline laboratory measures of interest. Linear mixed model regression was used to determine the important components of cardiometabolic risk profile at baseline that were associated with future progression of WMH. These analyses were controlled for age and sex. Sensitivity analyses were conducted using stratification by sex. The main outcome measure was percent change in WMH normalized to total intracranial volume. Three sets of models were constructed to evaluate individual (1) midlife risk factors, (2) current risk factors including the presence of metabolic syndrome and its constituents, and (3) baseline measurements of continuous laboratory measures of cardiometabolic risk. Results- Age was the strongest predictor of progression in WMH (P<0.001). Baseline hypertension (P<0.001), midlife hypertension (P=0.003), and baseline fasting glucose in males (P=0.01) were predictive of WMH change. The presence of metabolic syndrome was not associated with progressive WMH. In sensitivity analyses, associations between hypertension and WMH progression were stronger in females. Baseline serum glucose was associated with increase in WMH but was not significant in females in the stratified analysis. Other continuous laboratory measures of vascular risk were not associated with progressive WMH. Conclusions- Midlife and current hypertension in all participants and fasting glucose in males were associated with quantitative changes in white matter. Prospective clinical studies should determine optimal blood pressure to reduce stroke and cognitive impairment during aging.",
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T1 - Cardiometabolic Health and Longitudinal Progression of White Matter Hyperintensity

T2 - The Mayo Clinic Study of Aging

AU - Scharf, Eugene L.

AU - Graff-Radford, Jonathan

AU - Przybelski, Scott A.

AU - Lesnick, Timothy G.

AU - Mielke, Michelle M.

AU - Knopman, David S.

AU - Preboske, Gregory M.

AU - Schwarz, Christopher G.

AU - Senjem, Matthew L.

AU - Gunter, Jeffrey L.

AU - Machulda, Mary

AU - Kantarci, Kejal

AU - Petersen, Ronald C.

AU - Jack, Clifford R.

AU - Vemuri, Prashanthi

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N2 - Background and Purpose- White matter hyperintensity (WMH) burden is associated with stroke and cognitive decline. Risk factors associated with the longitudinal progression of WMH in the general population have not been systematically investigated. To investigate the primary midlife and current cardiometabolic risk factors associated with changes in WMH over time in a population cohort. Methods- This cohort study included participants enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study in Olmsted County, Minnesota with at least 2 consecutive WMH assessments on fluid-attenuated inversion recovery-magnetic resonance images (n=554, ≥60 years with midlife assessments) with relevant baseline laboratory measures of interest. Linear mixed model regression was used to determine the important components of cardiometabolic risk profile at baseline that were associated with future progression of WMH. These analyses were controlled for age and sex. Sensitivity analyses were conducted using stratification by sex. The main outcome measure was percent change in WMH normalized to total intracranial volume. Three sets of models were constructed to evaluate individual (1) midlife risk factors, (2) current risk factors including the presence of metabolic syndrome and its constituents, and (3) baseline measurements of continuous laboratory measures of cardiometabolic risk. Results- Age was the strongest predictor of progression in WMH (P<0.001). Baseline hypertension (P<0.001), midlife hypertension (P=0.003), and baseline fasting glucose in males (P=0.01) were predictive of WMH change. The presence of metabolic syndrome was not associated with progressive WMH. In sensitivity analyses, associations between hypertension and WMH progression were stronger in females. Baseline serum glucose was associated with increase in WMH but was not significant in females in the stratified analysis. Other continuous laboratory measures of vascular risk were not associated with progressive WMH. Conclusions- Midlife and current hypertension in all participants and fasting glucose in males were associated with quantitative changes in white matter. Prospective clinical studies should determine optimal blood pressure to reduce stroke and cognitive impairment during aging.

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