© 1999 American Heart Association, Inc.
Original Contributions |
Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults
The Cardiovascular Health Study
From the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (G.L.B., G.E.); the Department of Radiology, Tufts New England Medical Center, Boston, Mass (D.H.O.); the Department of Radiology, Johns Hopkins University, Maryland, Baltimore, Md (N.B.); the Department of Neurology, University of Pittsburgh, Pa (L.K.); and the Department of Biostatistics, University of Washington, Seattle, Wash (B.W.).
Correspondence to Teri Manolio, MD, MHS, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, Room 8160, Bethesda, MD 20892-7934. E-mail manolio{at}nih.gov
Abstract—Cerebral magnetic
resonance imaging (MRI) has demonstrated a high prevalence of
infarct-like lesions, white matter hyperintensities, and evidence of
cerebral atrophy in older adults. While these findings are generally
believed to be related to ischemia and
atherosclerosis, their relationship to
atherosclerosis in the carotid arteries remains to be
explored. Study subjects were part of the multicenter
Cardiovascular Health Study, a cross-sectional study of
3502 women and men 
65 years of age undergoing cranial MRI and
carotid ultrasonography. MRI infarcts were detected in 1068
participants (29.3%) and measurable carotid plaque in 2745 (75.3%).
MRI infarcts, ventricular and sulcal widening, and white
matter score were strongly associated with carotid intimal-medial
thickness (IMT) and stenosis degree after adjustment for age
and sex (all P<0.01). Associations with plaque
characteristics were less strong and less consistent; MRI
infarcts were weakly associated only with surface irregularity, and
ventricular size was weakly associated only with lesion
density (both P<0.04). In contrast, sulcal widening was
strongly related to plaque characteristics, with scores being higher in
those with heterogeneous and irregular plaque (both
P<0.009). Adjustment for other risk factors, and
for carotid IMT/stenosis, removed associations of MRI findings
with plaque characteristics except for weak relationships remaining
between MRI infarcts and surface irregularity and between sulcal score
and heterogeneous plaque (both P<0.03). MRI
abnormalities show strong and consistent relationships with
increasing carotid IMT and stenosis degree but less strong
associations with plaque characteristics, especially after adjusting
for IMT and stenosis.
Key Words: stroke • cerebrovascular disorders • carotid arteries • atherosclerosis • aged • epidemiology • risk factors
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