Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease

Sonia S Anand; Jack V Tu; Dipika Desai; Phillip Awadalla; Paula Robson; Sébastien Jacquemont; Trevor Dummer; Nhu Le; Louise Parker; Paul Poirier; Koon Teo; Scott A Lear; Salim Yusuf; Jean-Claude Tardif; Francois Marcotte; David Busseuil; Jean-Pierre Després; Sandra E Black; Anish Kirpalani; Grace Parraga; Michael D Noseworthy; Alexander Dick; Jonathan Leipsic; David Kelton; Jennifer Vena; Melissa Thomas; Karleen M Schulze; Eric Larose; Alan R Moody; Eric E Smith; Matthias G Friedrich

doi:10.1093/ehjci/jez226

Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease

Eur Heart J Cardiovasc Imaging. 2020 Jun 1;21(6):692-700. doi: 10.1093/ehjci/jez226.

Authors

Sonia S Anand^{1

2}, Jack V Tu³, Dipika Desai¹, Phillip Awadalla⁴, Paula Robson⁵, Sébastien Jacquemont^{6

7}, Trevor Dummer⁸, Nhu Le⁹, Louise Parker¹⁰, Paul Poirier¹¹, Koon Teo^{1

2}, Scott A Lear¹², Salim Yusuf^{1

2}, Jean-Claude Tardif¹³, Francois Marcotte¹³, David Busseuil¹³, Jean-Pierre Després¹⁴, Sandra E Black^{15

16}, Anish Kirpalani¹⁷, Grace Parraga^{18

19}, Michael D Noseworthy^{20

21}, Alexander Dick²², Jonathan Leipsic²³, David Kelton²⁴, Jennifer Vena²⁵, Melissa Thomas¹, Karleen M Schulze^{1

2}, Eric Larose¹¹, Alan R Moody²⁶, Eric E Smith²⁷, Matthias G Friedrich²⁸

Affiliations

¹ Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.
² Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
³ Department of Medicine, University of Toronto, ICES, Sunnybrook Schulich Heart Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
⁴ Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, 661 University Avenue Suite 510, Toronto, Ontario M5G 0A3, Canada.
⁵ Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Suite 1500 Sun Life Place, 10123 99th Street NW, Edmonton, Alberta T5J 3H1, Canada.
⁶ Department of Medicine, Université de Montréal, CHU Sainte Justine; 3175 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
⁷ Department of Pediatrics, Université de Montréal, CHU Sainte Justine, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
⁸ School of Population and Public Health, University of British Columbia, 675 W 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada.
⁹ Department of Statistics, BC Cancer Agency, University of British Columbia, 675 W 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada.
¹⁰ Department of Medicine, Dalhousie University; 1494 Carlton Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
¹¹ Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec G1V 4G5, Canada.
¹² Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
¹³ Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada.
¹⁴ Department of Kinesiology, Université Laval, 2325 rue de l'Université, Québec, Québec G1V 0A6, Canada.
¹⁵ Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
¹⁶ Hurvitz Brain Sciences Research Program Director, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
¹⁷ Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
¹⁸ Department of Medical Biophysics, Western University, 1151 Richmond Street North, London, Ontario N6A 5C1, Canada.
¹⁹ Robarts Research Institute, Western University, 1151 Richmond Street North, London, Ontario N6A 5B7, Canada.
²⁰ Department of Electrical and Computer Engineering, School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
²¹ Diagnostic Imaging, St. Joseph's Health Care, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
²² Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
²³ Department of Radiology, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
²⁴ Diagnostic Imaging, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Street East, Brampton, Ontario L6R 3J7, Canada.
²⁵ Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW Calgary, Alberta T2T 5C7, Canada.
²⁶ Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
²⁷ Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
²⁸ Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.

Abstract

Aims: Cardiovascular risk factors are used for risk stratification in primary prevention. We sought to determine if simple cardiac risk scores are associated with magnetic resonance imaging (MRI)-detected subclinical cerebrovascular disease including carotid wall volume (CWV), carotid intraplaque haemorrhage (IPH), and silent brain infarction (SBI).

Methods and results: A total of 7594 adults with no history of cardiovascular disease (CVD) underwent risk factor assessment and a non-contrast enhanced MRI of the carotid arteries and brain using a standardized protocol in a population-based cohort recruited between 2014 and 2018. The non-lab-based INTERHEART risk score (IHRS) was calculated in all participants; the Framingham Risk Score was calculated in a subset who provided blood samples (n = 3889). The association between these risk scores and MRI measures of CWV, carotid IPH, and SBI was determined. The mean age of the cohort was 58 (8.9) years, 55% were women. Each 5-point increase (∼1 SD) in the IHRS was associated with a 9 mm3 increase in CWV, adjusted for sex (P < 0.0001), a 23% increase in IPH [95% confidence interval (CI) 9-38%], and a 32% (95% CI 20-45%) increase in SBI. These associations were consistent for lacunar and non-lacunar brain infarction. The Framingham Risk Score was also significantly associated with CWV, IPH, and SBI. CWV was additive and independent to the risk scores in its association with IPH and SBI.

Conclusion: Simple cardiovascular risk scores are significantly associated with the presence of MRI-detected subclinical cerebrovascular disease, including CWV, IPH, and SBI in an adult population without known clinical CVD.

Keywords: atherosclerosis; magnetic resonance imaging; risk factors; silent brain infarction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular Diseases* / diagnostic imaging
Cardiovascular Diseases* / epidemiology
Cerebrovascular Disorders* / diagnostic imaging
Cerebrovascular Disorders* / epidemiology
Female
Heart Disease Risk Factors
Humans
Magnetic Resonance Imaging
Middle Aged
Plaque, Atherosclerotic*
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding