Aortic, Cardiovascular Disease and Silent Brain Infarcts

描述(申请人提供)：MRI检测到的亚临床脑梗塞在老年人群中非常普遍。它们作为症状性中风或其他血管事件的预测指标的意义存在争议。无症状性脑梗塞的危险因素知之甚少，关于无症状性脑梗塞与主动脉、心脏或24小时血压异常之间的关系也知之甚少，众所周知，这些异常与症状性中风密切相关。在第一个周期中，我们展示了大主动脉斑块在老年人中作为独立的卒中危险因素的作用，以及凝血和血脂异常作为增加卒中风险的辅助因素的作用。竞争延续将集中在亚临床脑梗塞及其与主动脉、亚临床心脏异常和24小时血压异常的关系，试图确定有症状中风、心肌梗死和血管死亡风险增加的受试者。 对900名60岁以上无中风的志愿者进行了一项具有前瞻性随访的横断面研究，其目的如下：1)在调整常规血管危险因素后，确定主动脉异常是否与老年无症状性脑梗塞独立相关。2)在调整常规血管危险因素后，确定心脏异常是否与老年人无症状性脑梗塞独立相关。3)在调整常规血管危险因素后，确定24小时血压异常是否与老年人无症状性脑梗塞相关。4)确定主动脉、心脏和24小时血压异常是否与未来血管事件和死亡的风险独立相关。 作为北曼哈顿研究(NOMAS)的一部分，所有受试者都将接受头部核磁共振检查，以进行亚临床脑部疾病检测，这一安排将确保登记，并极大地提高本申请的效率。近端主动脉异常和心脏异常将通过经胸超声心动图和一种新的三维经胸成像进行评估。还将进行24小时动态血压监测。主动脉/心脏/24小时血压异常和无症状脑梗塞的优势比将通过Logistic回归分析在总人口和种族亚组中计算，并对其他中风风险因素进行调整。受试者将接受每年一次的电话访问，以确定中风、心肌梗塞和死亡。这项应用将有助于填补老年人在无症状脑梗塞及其危险因素方面的知识空白，并在症状性中风或其他血管事件发生之前识别风险较高的对象。

DESCRIPTION (provided by applicant): Subclinical brain infarcts, detected by MRI, are highly prevalent in the elderly population. Their significance as predictors of symptomatic stroke or other vascular events is controversial. The risk factors for silent brain infarcts are poorly understood, and very little is known on the relationship between silent infarcts and aortic, cardiac or 24-hour blood pressure abnormalities, which are known to be strongly associated with symptomatic stroke. In the first cycle, we demonstrated the role of large aortic plaques as independent stroke risk factors in the elderly, and the role of coagulation and lipid abnormalities as co-factors in increasing the stroke risk. The competing continuation will focus on subclinical brain infarcts and their relationship with aortic, subclinical cardiac abnormalities and 24-hour blood pressure abnormalities, in an attempt to identify subjects at increased risk of symptomatic stroke, myocardial infarction and vascular death. A cross-sectional study with prospective follow-up is proposed on 900 stroke-free volunteers over the age of 60 with the following aims: 1) To determine if aortic abnormalities are independently associated with silent brain infarcts in the elderly after adjusting for conventional vascular risk factors. 2) To determine if cardiac abnormalities are independently associated with silent brain infarcts in the elderly after adjusting for conventional vascular risk factors. 3) To determine if 24-hour blood pressure abnormalities are associated with silent brain infarcts in the elderly after adjusting for conventional vascular risk factors. 4) To determine if aortic, cardiac and 24-hour blood pressure abnormalities are independently associated with future risk of vascular events and death. All subjects will undergo head MRI for subclinical brain disease detection as part of the Northern Manhattan Study (NOMAS), an arrangement that will guarantee enrollment and greatly increase the efficiency of the present application. Proximal aortic abnormalities and cardiac abnormalities will be assessed by transthoracic echocardiography with a novel 3-dimensional transthoracic imaging. 24-hour ambulatory blood pressure monitoring will also be performed. Odds ratio for aortic/cardiac/24-hour blood pressure abnormalities and silent brain infarcts will be calculated by logistic regression analysis in the overall population and in race-ethnic subgroups, adjusting for other stroke risk factors. Subjects will be followed by annual telephone interviews to ascertain stroke, myocardial infarction, and death. The present application will help fill gaps in knowledge on silent brain infarcts and their risk factors in the elderly, and identify subjects at higher risk before a symptomatic stroke or other vascular event occurs.