Progression of Magnetic Resonance Imaging-Defined Brain Vascular Disease Predicts Vascular Events in Elderly The Cardiovascular Health Study

Background and Purpose-To determine whether progression of MRI-defined vascular disease predicts subsequent vascular events in the elderly. Methods-The Cardiovascular Health Study, a longitudinal cohort study of vascular disease in the elderly, allows us to address this question because its participants had 2 MRI scans approximate to 5 years apart and have been followed for approximate to 9 years since the follow-up scan for incident vascular events. Results-Both MRI-defined incident infarcts and worsened white matter grade were significantly associated with heart failure, stroke, and death, but not transient ischemic attacks, angina, or myocardial infarction. Strongest associations occurred when both incident infarcts and worsened white matter grade were present for heart failure (hazard ratio, 1.79; 95% confidence interval, 1.18-2.73), stroke (hazard ratio, 2.58; 95% confidence interval, 1.53-4.36), death (hazard ratio, 1.69; 95% confidence interval, 1.28-2.24), and cardiovascular death (hazard ratio, 1.97; 95% confidence interval, 1.24-3.14). Conclusions-Progression of MRI-defined vascular disease identifies elderly people at increased risk for subsequent heart failure, stroke, and death. Whether aggressive risk factor management would reduce risk is unknown. (Stroke. 2011;42:2970-2972.)