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Subclinical cerebrovascular disease increases the risk of incident stroke and mortality: the Northern Manhattan study
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نویسنده
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wright c.b. ,dong c. ,perez e.j. ,de rosa j. ,yoshita m. ,rundek t. ,de carli c. ,gutierrez j. ,elkind m.s.v. ,sacco r.l.
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منبع
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journal of the american heart association - 2017 - دوره : 6 - شماره : 9
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چکیده
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Background--the effects of white matter hyperintensity volume and subclinical brain infarcts on the risk of incident stroke,its ischemic subtypes,and mortality require further study in diverse samples. methods and results--stroke-free participants in the northern manhattan study underwent magnetic resonance imaging (n=1287; mean age 71±9 years,60% women,15% non-hispanic white,17% non-hispanic black,68% hispanic) and were followed for a median of 8 years (interquartile range: 6-9 years). cox models estimated proportional hazards of incident stroke of all types,ischemic stroke (and its subtypes),and mortality and stratified by race/ethnicity. in total 72 participants (6%) had incident strokes and 244 died (19%). in fully adjusted models,those with larger white matter hyperintensity volume had greater risk of all stroke types (hazard ratio [hr]: 1.4; 95% ci,1.1-1.9),ischemic stroke (hr: 1.3; 95% ci,1.0-1.8),and cryptogenic stroke (hr: 2.2; 95% ci,1.1-4.4). white and black but not hispanic participants had increased stroke risk (p < 0.05 for heterogeneity for all and ischemic stroke). those with subclinical brain infarct had greater risk for all stroke types (hr: 1.9; 95% ci,1.1-3.3),ischemic stroke (hr: 2.2; 95% ci,1.3-3.8),lacunar (hr: 4.0; 95% ci,1.3-12.3),and cryptogenic stroke (hr: 3.6; 95% ci,1.0-12.7),without significant heterogeneity across race/ethnic groups. greater white matter hyperintensity volume increased both vascular (hr: 1.3; 95% ci,1.1-1.7) and nonvascular (hr: 1.2; 95% ci,1.0-1.5) mortality among hispanic and white but not black participants (p=0.040 for heterogeneity). subclinical brain infarct was associated with increased vascular mortality among hispanic participants only (hr: 2.9; 95% ci,1.4-5.8). conclusions--in this urban us sample,subclinical cerebrovascular lesions increased the risk of clinical stroke and vascular mortality and varied by race/ethnicity and lesion type. © 2017 the authors.
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کلیدواژه
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Cerebrovascular disease/stroke; Epidemiology; Mortality; Stroke; White matter disease
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آدرس
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evelyn f. mcknight brain institute,leonard m. miller school of medicine,university of miamifl,united states,department of neurology,leonard m. miller school of medicine,university of miamifl,united states,department of public health sciences,leonard m. miller school of medicine,university of miamifl,united states,department of neuroscience program,leonard m. miller school of medicine,university of miamifl, United States, evelyn f. mcknight brain institute,leonard m. miller school of medicine,university of miamifl,united states,department of neurology,leonard m. miller school of medicine,university of miamifl, United States, evelyn f. mcknight brain institute,leonard m. miller school of medicine,university of miamifl,united states,department of neuroscience program,leonard m. miller school of medicine,university of miamifl, United States, department of neurology,college of physicians and surgeons,new york,ny,united states,department of epidemiology,mailman school of public health,columbia university,new york,ny, United States, national hospital organization,hokuriku national hospital,nanto, Japan, evelyn f. mcknight brain institute,leonard m. miller school of medicine,university of miamifl,united states,department of neurology,leonard m. miller school of medicine,university of miamifl,united states,department of public health sciences,leonard m. miller school of medicine,university of miamifl,united states,department of human genomics,leonard m. miller school of medicine,university of miamifl, United States, department of neurology,university of california at davis health system,sacramento,ca, United States, department of neurology,college of physicians and surgeons,new york,ny,united states,department of epidemiology,mailman school of public health,columbia university,new york,ny, United States, department of neurology,college of physicians and surgeons,new york,ny,united states,department of epidemiology,mailman school of public health,columbia university,new york,ny, United States, evelyn f. mcknight brain institute,leonard m. miller school of medicine,university of miamifl,united states,department of neurology,leonard m. miller school of medicine,university of miamifl,united states,department of public health sciences,leonard m. miller school of medicine,university of miamifl,united states,department of human genomics,leonard m. miller school of medicine,university of miamifl, United States
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Authors
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