Risk Factors Associated With Incident Cerebral Microbleeds According to Location in Older People: The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study.
Risk Factors Associated With Incident Cerebral Microbleeds According to Location in Older People: The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study.
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DOI：
10.1001/jamaneurol.2015.0174
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发表时间：
2015-06
期刊：
影响因子：
29
通讯作者：
Launer LJ
中科院分区：
文献类型：
--
作者：
Ding J;Sigurdsson S;Garcia M;Phillips CL;Eiriksdottir G;Gudnason V;van Buchem MA;Launer LJ
脑微出血（CMB）是脑出血的无症状前兆，其空间分布反映了脑淀粉样血管病（脑叶）和高血压血管病（脑深部结构）的特定潜在微血管病变。相对较少的是知道的发生和可改变的危险因素，为发展中国家的商业银行，特别是在一个肺叶的位置，在一般人群的老年人。调查生活方式和血脂因素是否能预测与其位置相关的新发CMB。年龄、基因/环境易感性（AGES）-雷克雅未克研究的基于人群的样本，包括2，635名年龄在66-93岁之间的个体。参与者在2002-2006年接受了基线脑部MRI检查，并在2007-2011年返回进行重复脑部MRI检查。基线时评估的生活方式和血脂因素，即吸烟、饮酒、体重指数、血清总胆固醇、高密度脂蛋白、低密度脂蛋白和甘油三酯水平。脑MRI检测到的事件CMB，进一步分为两个位置之一：严格的叶或深。在平均5.2年的随访中，486人（18.4%）发生了新的CMB，其中308人有严格的肺叶，178人有深CMB。在校正基线心血管危险因素（包括血压和抗高血压药物使用、普遍的CMB和脑缺血性小血管疾病标志物）的多变量对数二项回归模型中，重度饮酒（与轻度至中度饮酒相比，相对危险度[RR] 2.94; 95%CI，1.23至7.01）预测深部CMB事件。基线体重不足（相对于正常体重，2.41; 1.21至4.80），目前吸烟（1.47; 1.11 ~ 1.94），血清高密度脂蛋白胆固醇升高（每SD增加1.13; 1.02至1.25）和甘油三酯降低（自然对数转换的甘油三酯每SD降低1.17; 1.03至1.33）均与严格肺叶CMB风险增加显著相关，但与深部CMB无关。CMB的生活方式和血脂风险特征与症状性脑出血相似，而与脑叶和深部CMB不同。这些因素的修改可能有可能防止新发CMB，特别是那些发生在肺叶位置。
The spatial distribution of cerebral microbleeds (CMBs), which are asymptomatic precursors of intracerebral hemorrhage, reflects specific underlying microvascular pathologies of cerebral amyloid angiopathy (lobar) and hypertensive vasculopathy (deep brain structures). Relatively little is known about occurrence of and modifiable risk factors for developing CMBs, especially in a lobar location, in the general population of older people. To investigate whether lifestyle and lipid factors predict new CMBs in relation to their location. Population-based sample of the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study of 2,635 individuals aged 66–93 years. Participants underwent a baseline brain MRI examination in 2002–2006, and returned for a repeat brain MRI in 2007–2011. Lifestyle and lipids factors assessed at baseline, i.e. smoking, alcohol drinking, body mass index, serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and triglycerides. Brain MRI-detected incident CMBs, which were further categorized into one of two locations: strictly lobar or deep. During a mean follow-up of 5.2 years, 486 people (18.4%) developed new CMBs, of whom 308 had strictly lobar and 178 had deep CMBs. In the multivariate log-binomial regression model adjusting for baseline cardiovascular risk factors including blood pressure and antihypertensive use, prevalent CMBs and markers of cerebral ischemic small vessel disease, heavy alcohol consumption (versus light to moderate, relative risk [RR] 2.94; 95%CI, 1.23 to 7.01) predicted incident CMBs in a deep location. Baseline being underweight (versus normal weight, 2.41; 1.21 to 4.80), current smoking (1.47; 1.11 to 1.94), higher serum high-density lipoprotein cholesterol (per SD increase 1.13; 1.02 to 1.25) and lower triglycerides (per SD decrease in natural log-transformed triglycerides 1.17; 1.03 to 1.33) were each significantly associated with an increased risk for strictly lobar CMBs but not with deep CMBs. Lifestyle and lipids risk profiles for CMBs were similar to those for symptomatic intracerebral hemorrhage and differed for lobar and deep CMBs. Modification of these factors could have the potential to prevent new onset CMBs, particularly those occurring in a lobar location.