Aortic, Cardiovascular Disease and Silent Brain Infarcts

描述（由申请方提供）：通过MRI检测到的亚临床脑梗死在老年人群中非常普遍。它们作为症状性卒中或其他血管事件的预测因子的意义存在争议。无症状性脑梗死的危险因素知之甚少，并且对无症状性脑梗死与主动脉、心脏或24小时血压异常之间的关系知之甚少，已知其与症状性卒中密切相关。在第一个周期中，我们证明了大主动脉斑块作为老年人卒中独立危险因素的作用，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。竞争性继续研究将重点关注亚临床脑梗死及其与主动脉、亚临床心脏异常和24小时血压异常的关系，试图识别症状性卒中、心肌梗死和血管性死亡风险增加的受试者。 本文拟对900例60岁以上无脑卒中的志愿者进行前瞻性随访横断面研究，目的如下：1）在调整传统血管危险因素后，确定主动脉异常是否与老年人无症状性脑梗死独立相关。2)在调整传统血管危险因素后，确定心脏异常是否与老年人无症状性脑梗死独立相关。3)在调整传统血管危险因素后，确定24小时血压异常是否与老年人无症状脑梗死相关。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风险独立相关。 作为北方曼哈顿研究（NOMAS）的一部分，所有受试者都将接受头部MRI，以进行亚临床脑部疾病检测，这一安排将保证入组并大大提高本申请的效率。近端主动脉异常和心脏异常将通过经胸超声心动图和新型三维经胸成像进行评估。24-还将进行小时动态血压监测。将通过logistic回归分析计算总人群和人种-种族亚组中主动脉/心脏/24小时血压异常和无症状性脑梗死的比值比，并调整其他卒中风险因素。将对受试者进行年度电话随访，以确定卒中、心肌梗死和死亡。本申请将有助于填补关于老年人无症状脑梗塞及其风险因素的知识空白，并在症状性中风或其他血管事件发生之前识别处于较高风险的受试者。

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.