Table 2.
Association of Lesions and White Matter Hyperintensities (WMH) with Incident Stroke, Stroke Subtypes, Mortality, and Stroke Among ARIC Participants*
| Stroke (ANY) N=157 (8%) |
Ischemic Stroke N=140 (7%) |
Hemorrhagic Stroke N=15 (1%) |
All-cause mortality N=576 (31%) |
Stroke Mortality N=50 (10%) |
||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Lesion Type | ||||||||||
| None (N=1611, 86%) |
-ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- |
| Very small (<3mm Only) (N=50, 3%) |
3.47 (1.86, 6.49) | <0.001 | 3.10 (1.57, 6.12) | 0.001 | 17.25 (4.05, 73.46) | <0.001 | 1.34 (0.84, 2.13) | 0.217 | 3.05 (1.04, 8.94) | 0.043 |
| Larger (≥3mm Only) (N=185, 10%) |
1.94 (1.22, 3.07) | 0.005 | 1.83 (1.12, 2.99) | 0.015 | 2.60 (0.47, 14.49) | 0.276 | 1.90 (1.48, 2.44) | <0.001 | 1.87 (0.83, 4.23) | 0.132 |
| Both (Very Small & Larger) (N=35, 2%) |
8.59 (4.69, 15.73) | <0.001 | 6.88 (3.58, 13.22) | <0.001 | 26.67 (5.21, 136.46) | <0.001 | 1.89 (1.14, 3.13) | 0.013 | 6.97 (2.03, 23.93) | 0.002 |
| Any Lesions <3mm (N=85, 5%) vs no lesions |
4.94 (3.08, 7.92) | <0.001 | 4.17 (2.51, 6.94) | <0.001 | 21.64 (6.19, 75.73) | <0.001 | 1.49 (1.04, 2.13) | 0.031 | 5.14 (2.08, 12.73) | <0.001 |
| Count of Lesions <3mm | ||||||||||
| 0 (N=1611, 95%) | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- |
| 1 to 2 (N=73, 4%) | 4.87 (2.99, 7.93) | <0.001 | 4.03 (2.37, 6.85) | <0.001 | 20.27 (5.55, 73.97) | <0.001 | 1.39 (0.94, 2.06) | 0.095 | 5.87 (2.33, 14.78) | <0.001 |
| >2 (N=12, 1%) | 5.72 (1.64, 19.94) | 0.006 | 5.73 (1.62, 20.24) | 0.007 | § | § | 2.13 (0.98, 4.66) | 0.058 | § | § |
| Any Lesions ≥3mm (N=220, 12%) vs no lesions |
2.54 (1.70, 3.79) | <0.001 | 2.35 (1.54, 3.60) | <0.001 | 6.42 (1.68, 24.44) | 0.006 | 1.88 (1.48, 2.37) | <0.001 | 2.63 (1.25, 5.52) | 0.011 |
| Any Non-lacunes ≥3mm† (N=32, 2%) |
4.92 (2.31, 10.49) | <0.001 | 5.41 (2.52, 11.61) | <0.001 | 16.40 (1.52, 177.32) | 0.021 | 3.90 (2.35, 6.46) | <0.001 | § | § |
| Any Lacunes 3–20mm† (N=188, 10%) |
2.30 (1.49, 3.55) | <0.001 | 2.04 (1.28, 3.25) | 0.003 | 7.14 (1.63, 31.34) | 0.009 | 1.69 (1.31, 2.17) | <0.001 | 3.33 (1.57, 7.05) | 0.002 |
| # of Lacunes 3–20mm‡ | ||||||||||
| 0 (N=1611, 90%) | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- |
| 1 (N=132, 7%) | 1.81 (1.06, 3.08) | 0.029 | 1.83 (1.05, 3.16) | 0.032 | 2.46 (0.26, 23.71) | 0.436 | 1.47 (1.09, 1.98) | 0.012 | 1.94 (0.78, 4.86) | 0.155 |
| ≥2 (N=56, 3%) | 3.64 (1.98, 6.69) | <0.001 | 2.58 (1.26, 5.28) | 0.009 | 23.24 (3.96, 136.48) | <0.001 | 2.36 (1.59, 3.50) | <0.001 | 11.71 (4.10, 33.47) | <0.001 |
| WMH (Grades 0–9) | 1.30 (1.15, 1.46) | <0.001 | 1.30 (1.14, 1.47) | <0.001 | 1.42 (0.99, 2.03) | 0.054 | 1.20 (1.12, 1.29) | <0.001 | 1.35 (1.10, 1.66) | 0.004 |
| WMH Grade (high vs low) | ||||||||||
| Low <3 (N=1658, 88%) | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- | -ref- |
| High ≥3 (N=223, 12%) | 2.14 (1.45, 3.16) | <0.001 | 2.12 (1.41, 3.20) | <0.001 | 3.13 (0.93, 10.54) | 0.066 | 1.78 (1.42, 2.23) | <0.001 | 2.47 (1.25, 4.87) | 0.009 |
Values in table are HRs (95% CI) from Cox PHMs adjusted for age, sex, race-site, education, BMI, smoking, alcohol, diabetes, systolic and diastolic blood pressures, hypertension medication use, heart disease, HDL, LDL, triglycerides, statin use; all estimates compared to reference group of “no lesions” (n=1611) except WMH.
Lacunes = 3–20 mm lesions in the basal ganglia, brain stem, thalamus, internal capsule, or cerebral white matter (including those who may also have small infarcts); non-lacunar lesions were any lesions 3–20 mm not located in these areas or >20 mm in any area on right-to-left or anterior-to-posterior measurements
Includes 31 participants who also had a very small lesion (<3mm)
Too few data to support estimates