Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults: The Cardiovascular Health Study
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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.
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Proposed mechanisms linking atherosclerotic cerebrovascular pathology to vascular cognitive impairment include thrombotic occlusion of large vessels with subsequent chronic cerebral hypoperfusion, cerebral embolism from ruptured or thrombotic carotid plaques targeting distal vessels, increased parenchymal oxidative stress, blood pressure dysregulation affecting blood-brain barrier integrity, and a
“The mechanisms by which atherosclerotic cerebrovascular pathology might be associated with VCI include thrombotic occlusion of large vessels with subsequent chronic cerebral hypoperfusion; cerebral embolism originating from ruptured or thrombotic carotid plaques and targeting distal vessels; increased parenchymal oxidative stress; blood pressure dys-regulation affecting BBB integrity; and a common”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [198]
The “Carotid Disease and the Brain” section (page unavailable) proposes large-vessel occlusion with hypoperfusion and embolism from ruptured or thrombotic carotid plaques. It does not describe the hypoperfusion as chronic or propose oxidative stress or blood-pressure dysregulation affecting blood–brain barrier integrity as mechanisms. (LLM, conf=0.90)
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- Authors
- Manolio, T. A., Burke, G. L., O’Leary, D. H., Evans, G., Beauchamp, N., Knepper, L., & Ward, B.
- Affiliations
- Tufts Medical Center (US)
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 1999-02
- Volume
- 19
- Issue
- 2
- Pages
- 356-365
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W2136884727
- Cited by
- 194
- References
- 42
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 3 · 2022: 8 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 7 · 2016: 6 · 2015: 8 · 2014: 9 · 2013: 14 · 2012: 8
- FWCI
- 4.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc085086-022)
- National Heart, Lung, and Blood Institute (HC-85086, N01-HC-15093, N01 HC85086, N01-HC, N01-HC-5079)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- carotid atherosclerosis, brain MRI, white matter hyperintensities, brain atrophy, carotid intima-media thickness, carotid artery stenosis, carotid plaque characteristics, ventriculomegaly, older adults, Cardiovascular Health Study
- MeSH terms
- Aged, Arteriosclerosis, Brain, Cardiovascular System, Carotid Artery Diseases, Cerebral Infarction, Cross-Sectional Studies, Echoencephalography, Female, Health Status, Humans, Magnetic Resonance Imaging, Male, Cohort Studies, Prevalence
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