Silent brain infarct is independently associated with arterial stiffness indicated by cardio-ankle vascular index (CAVI)

It is still unclear whether silent brain infarct (SBI) and white-matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scans are associated with cardio-ankle vascular index (CAVI), a novel parameter of arterial stiffness. We studied 220 consecutive patients (mean age, 69 years) without a history of stroke or transient ischemic attack. Patients were assessed for the presence of SBI, WMHs and risk factors. Arterial stiffness was evaluated using CAVI. Patients were categorized into one of two groups according to the presence or absence of SBI and WMHs, and clinical characteristics were compared between the two groups. CAVI was significantly higher in patients with SBI or in patients with WMHs than in those without those respective findings. The CAVI cutoff values for detection of SBI and WMHs were 9.2 and 8.9, respectively. On multivariable analyses, CAVI, a one point increase in CAVI: odds ratio (OR), 1.25; 95% confidence interval (CI), 1.01–1.56; CAVI⩾9.2: OR, 2.34; 95% CI, 1.16–5.02, was independently associated with SBI, however, CAVI was not independently associated with WMHs. Patients with CAVI ⩾9.2 had higher OR for the presence of both SBI and WMHs (OR, 2.57; 95% CI, 1.15–5.98) when compared with patients with CAVI <9.2 after adjustment for age and sex. SBI is independently associated with arterial stiffness indicated by CAVI.

[1]  H. Ueshima,et al.  Brachial–ankle pulse wave velocity predicts all-cause mortality in the general population: findings from the Takashima study, Japan , 2010, Hypertension Research.

[2]  H. Rakugi,et al.  The combination of chronic kidney disease and increased arterial stiffness is a predictor for stroke and cardiovascular disease in hypertensive patients , 2011, Hypertension Research.

[3]  T. Kawarai,et al.  Clinical features of a first-ever lacunar infarction in Japanese patients: poor outcome in females. , 2011, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[4]  T. Ogihara,et al.  Comparison of Arterial Functional Evaluations as a Predictor of Cardiovascular Events in Hypertensive Patients: The Non-Invasive Atherosclerotic Evaluation in Hypertension (NOAH) Study , 2008, Hypertension Research.

[5]  A. Hofman,et al.  Silent Brain Infarcts and White Matter Lesions Increase Stroke Risk in the General Population: The Rotterdam Scan Study , 2003, Stroke.

[6]  Jae-Sung Lim,et al.  Risk of “silent stroke” in patients older than 60 years: risk assessment and clinical perspectives , 2010, Clinical interventions in aging.

[7]  Peter W de Leeuw,et al.  Increased Aortic Pulse Wave Velocity Is Associated With Silent Cerebral Small-Vessel Disease in Hypertensive Patients , 2008, Hypertension.

[8]  Toshinori Hirai,et al.  Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three types of magnetic resonance images: a multicenter observer performance study , 2008, Neuroradiology.

[9]  H. Yagi,et al.  Comparison of Atherosclerotic Indicators Between Cardio Ankle Vascular Index and Brachial Ankle Pulse Wave Velocity , 2009, Angiology.

[10]  H. Struijker‐Boudier,et al.  Expert consensus document on arterial stiffness: methodological issues and clinical applications. , 2006, European heart journal.

[11]  K. Kohara,et al.  Association of central systolic blood pressure with intracerebral small vessel disease in Japanese. , 2010, American journal of hypertension.

[12]  Hirokazu Bokura,et al.  Silent brain infarction and subcortical white matter lesions increase the risk of stroke and mortality: a prospective cohort study. , 2006, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[13]  F. Fazekas,et al.  MRI white matter hyperintensities , 1999, Neurology.

[14]  J. Lekakis,et al.  Incremental predictive value of carotid intima–media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives , 2010, Hypertension Research.

[15]  Takanobu Tomaru,et al.  Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. , 2011, Journal of atherosclerosis and thrombosis.

[16]  T. Kawarai,et al.  Increased Brachial-Ankle Pulse Wave Velocity Is Independently Associated with White Matter Hyperintensities , 2011, Neuroepidemiology.

[17]  M. Matsuda,et al.  Relationship of cardio-ankle vascular index (CAVI) to carotid and coronary arteriosclerosis. , 2008, Circulation journal : official journal of the Japanese Circulation Society.

[18]  F. Fazekas,et al.  Pathologic correlates of incidental MRI white matter signal hyperintensities , 1993, Neurology.

[19]  T. Sasaguri,et al.  Chronic kidney disease and subclinical lacunar infarction are independently associated with frontal lobe dysfunction in community-dwelling elderly subjects: the Sefuri brain MRI study , 2011, Hypertension Research.

[20]  K. Asayama,et al.  Association of Arterial Stiffness with Silent Cerebrovascular Lesions: The Ohasama Study , 2011, Cerebrovascular Diseases.

[21]  J. M. Wardlaw,et al.  Blood-brain barrier and cerebral small vessel disease , 2010, Journal of the Neurological Sciences.

[22]  R. Sakakibara,et al.  Stroke and cardio-ankle vascular stiffness index. , 2013, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[23]  W. Ryu,et al.  Advanced coronary artery calcification and cerebral small vessel diseases in the healthy elderly. , 2011, Circulation journal : official journal of the Japanese Circulation Society.

[24]  A. Lee,et al.  Increased brachial–ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients , 2008, Clinical Neurology and Neurosurgery.

[25]  K. Otsuka,et al.  Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up , 2009, Dementia and Geriatric Cognitive Disorders.

[26]  M. Matsumoto,et al.  Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions , 2007, Hypertension Research.

[27]  Yoshihiko Maehara,et al.  Association between Arterial Stiffness and Cerebral White Matter Lesions in Community-Dwelling Elderly Subjects , 2008, Hypertension Research.

[28]  K. Asayama,et al.  Association of Kidney Dysfunction with Silent Lacunar Infarcts and White Matter Hyperintensity in the General Population: The Ohasama Study , 2010, Cerebrovascular Diseases.

[29]  C. Vlachopoulos,et al.  Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness , 2011 .

[30]  L. Pantoni Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges , 2010, The Lancet Neurology.

[31]  K. Kimura,et al.  Association between silent brain infarct and arterial stiffness indicated by brachial-ankle pulse wave velocity. , 2012, Internal medicine.

[32]  J. Higaki,et al.  Relationship between Cardio-Ankle Vascular Index (CAVI) and Carotid Atherosclerosis in Patients with Essential Hypertension , 2007, Hypertension Research.

[33]  H. Markus,et al.  Magnetic Resonance Imaging in Cerebral Small Vessel Disease and its Use as a Surrogate Disease Marker , 2011, International journal of stroke : official journal of the International Stroke Society.

[34]  T. Ohtsuki,et al.  Association between central systolic blood pressure, white matter lesions in cerebral MRI and carotid atherosclerosis , 2009, Hypertension Research.