Cerebral white matter lesions, retinopathy, and incident clinical stroke

Tien Yin Wong, Ronald Klein, A. Richey Sharrett, David J. Couper, Barbara E K Klein, Duan Ping Liao, Larry D. Hubbard, Thomas H. Mosley

Research output: Contribution to journalArticle

Abstract

Context: White matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to have a microvascular etiology and to precede the development of clinical stroke. However, few clinical data are available to support these hypotheses. Objective: To examine the relationship of WMLs, retinal microvascular abnormalities, and incident clinical stroke in healthy, middle-aged men and women. Design and Setting: The Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort study conducted in 4 US communities and initiated in 1987-1989. Participants: A total of 1684 persons aged 51 to 72 years who had cerebral magnetic resonance imaging (MRI) and retinal photography at the third examination (1993-1995). Main Outcome Measures: Odds of WMLs, defined by standardized methods from MRI, by presence or absence of specific retinal microvascular abnormality (eg, microaneurysm, retinal hemorrhage) on retinal photograph; incident clinical stroke, ascertained after a median follow-up of 4.7 years, according to presence or absence of WMLs and retinopathy. Results: Persons with retinopathy were more likely to have WMLs than those without retinopathy (22.9% vs 9.9%; odds ratio, 2.5; 95% confidence interval [Cl], 1.5-4.0, adjusted for age, sex, race, and vascular risk factors). The 5-year cumulative incidence of clinical stroke was higher in persons with vs without WMLs (6.8% vs 1.4%; adjusted relative risk [RR], 3.4; 95% Cl, 1.5-7.7) and in persons with vs without retinopathy (8.0% vs 1.4%; adjusted RR, 4.9; 95% Cl, 2.0-11.9). Persons with both WMLs and retinopathy had a significantly higher 5-year cumulative incidence of stroke than those without either WMLs or retinopathy (20.0% vs 1.4%; adjusted RR, 18.1; 95% Cl, 5.9-55.4). Conclusions: In this cohort, middle-aged persons with cerebral WMLs detected on MRI were more likely to have retinal microvascular abnormalities and to have an increased risk of clinical stroke than people without WMLs. The risk of stroke was higher when retinopathy was simultaneously present in persons with WMLs.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalJournal of the American Medical Association
Volume288
Issue number1
StatePublished - Jul 3 2002
Externally publishedYes

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Stroke
Magnetic Resonance Imaging
White Matter
Retinal Hemorrhage
Photography
Incidence
Atherosclerosis
Cohort Studies
Odds Ratio
Outcome Assessment (Health Care)
Prospective Studies
Confidence Intervals
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wong, T. Y., Klein, R., Richey Sharrett, A., Couper, D. J., Klein, B. E. K., Liao, D. P., ... Mosley, T. H. (2002). Cerebral white matter lesions, retinopathy, and incident clinical stroke. Journal of the American Medical Association, 288(1), 67-74.

Cerebral white matter lesions, retinopathy, and incident clinical stroke. / Wong, Tien Yin; Klein, Ronald; Richey Sharrett, A.; Couper, David J.; Klein, Barbara E K; Liao, Duan Ping; Hubbard, Larry D.; Mosley, Thomas H.

In: Journal of the American Medical Association, Vol. 288, No. 1, 03.07.2002, p. 67-74.

Research output: Contribution to journalArticle

Wong, TY, Klein, R, Richey Sharrett, A, Couper, DJ, Klein, BEK, Liao, DP, Hubbard, LD & Mosley, TH 2002, 'Cerebral white matter lesions, retinopathy, and incident clinical stroke', Journal of the American Medical Association, vol. 288, no. 1, pp. 67-74.
Wong TY, Klein R, Richey Sharrett A, Couper DJ, Klein BEK, Liao DP et al. Cerebral white matter lesions, retinopathy, and incident clinical stroke. Journal of the American Medical Association. 2002 Jul 3;288(1):67-74.
Wong, Tien Yin ; Klein, Ronald ; Richey Sharrett, A. ; Couper, David J. ; Klein, Barbara E K ; Liao, Duan Ping ; Hubbard, Larry D. ; Mosley, Thomas H. / Cerebral white matter lesions, retinopathy, and incident clinical stroke. In: Journal of the American Medical Association. 2002 ; Vol. 288, No. 1. pp. 67-74.
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AU - Wong, Tien Yin

AU - Klein, Ronald

AU - Richey Sharrett, A.

AU - Couper, David J.

AU - Klein, Barbara E K

AU - Liao, Duan Ping

AU - Hubbard, Larry D.

AU - Mosley, Thomas H.

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N2 - Context: White matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to have a microvascular etiology and to precede the development of clinical stroke. However, few clinical data are available to support these hypotheses. Objective: To examine the relationship of WMLs, retinal microvascular abnormalities, and incident clinical stroke in healthy, middle-aged men and women. Design and Setting: The Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort study conducted in 4 US communities and initiated in 1987-1989. Participants: A total of 1684 persons aged 51 to 72 years who had cerebral magnetic resonance imaging (MRI) and retinal photography at the third examination (1993-1995). Main Outcome Measures: Odds of WMLs, defined by standardized methods from MRI, by presence or absence of specific retinal microvascular abnormality (eg, microaneurysm, retinal hemorrhage) on retinal photograph; incident clinical stroke, ascertained after a median follow-up of 4.7 years, according to presence or absence of WMLs and retinopathy. Results: Persons with retinopathy were more likely to have WMLs than those without retinopathy (22.9% vs 9.9%; odds ratio, 2.5; 95% confidence interval [Cl], 1.5-4.0, adjusted for age, sex, race, and vascular risk factors). The 5-year cumulative incidence of clinical stroke was higher in persons with vs without WMLs (6.8% vs 1.4%; adjusted relative risk [RR], 3.4; 95% Cl, 1.5-7.7) and in persons with vs without retinopathy (8.0% vs 1.4%; adjusted RR, 4.9; 95% Cl, 2.0-11.9). Persons with both WMLs and retinopathy had a significantly higher 5-year cumulative incidence of stroke than those without either WMLs or retinopathy (20.0% vs 1.4%; adjusted RR, 18.1; 95% Cl, 5.9-55.4). Conclusions: In this cohort, middle-aged persons with cerebral WMLs detected on MRI were more likely to have retinal microvascular abnormalities and to have an increased risk of clinical stroke than people without WMLs. The risk of stroke was higher when retinopathy was simultaneously present in persons with WMLs.

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