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Jensen PN, Rashid T, Ware JB, Cui Y, Sitlani CM, Austin TR, Longstreth W, Bertoni AG, Mamourian E, Bryan RN, Nasrallah IM, Habes M, Heckbert SR. Association of brain microbleeds with risk factors, cognition, and MRI markers in MESA. Alzheimers Dement 2023; 19:4139-4149. [PMID: 37289978 PMCID: PMC11163989 DOI: 10.1002/alz.13346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Little is known about the epidemiology of brain microbleeds in racially/ethnically diverse populations. METHODS In the Multi-Ethnic Study of Atherosclerosis, brain microbleeds were identified from 3T magnetic resonance imaging susceptibility-weighted imaging sequences using deep learning models followed by radiologist review. RESULTS Among 1016 participants without prior stroke (25% Black, 15% Chinese, 19% Hispanic, 41% White, mean age 72), microbleed prevalence was 20% at age 60 to 64.9 and 45% at ≥85 years. Deep microbleeds were associated with older age, hypertension, higher body mass index, and atrial fibrillation, and lobar microbleeds with male sex and atrial fibrillation. Overall, microbleeds were associated with greater white matter hyperintensity volume and lower total white matter fractional anisotropy. DISCUSSION Results suggest differing associations for lobar versus deep locations. Sensitive microbleed quantification will facilitate future longitudinal studies of their potential role as an early indicator of vascular pathology.
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Affiliation(s)
- Paul N. Jensen
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98195, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - Tanweer Rashid
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio, San Antonio, Texas 78229, USA
| | - Jeffrey B. Ware
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19103, USA
| | - Yuhan Cui
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98195, USA
- Department of Medicine, University of Washington, Seattle, Washington 98195, USA
| | - Thomas R. Austin
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98195, USA
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
| | - W.T. Longstreth
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Department of Neurology, University of Washington, Seattle, Washington 98195, USA
| | - Alain G. Bertoni
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Elizabeth Mamourian
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19103, USA
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - R. Nick Bryan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19103, USA
| | - Ilya M. Nasrallah
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19103, USA
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Mohamad Habes
- Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio, San Antonio, Texas 78229, USA
- Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98195, USA
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
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Li Y, Liu X, Chen S, Wang J, Pan C, Li G, Tang Z. Effect of antiplatelet therapy on the incidence, prognosis, and rebleeding of intracerebral hemorrhage. CNS Neurosci Ther 2023; 29:1484-1496. [PMID: 36942509 PMCID: PMC10173719 DOI: 10.1111/cns.14175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Antiplatelet medications are increasingly being used for primary and secondary prevention of ischemic attacks owing to the increasing prevalence of ischemic stroke occurrences. Currently, many patients receive antiplatelet therapy (APT) to prevent thromboembolic events. However, long-term use of APT might also lead to an increased occurrence of intracerebral hemorrhage (ICH) and affect the prognosis of patients with ICH. Furthermore, some research suggest that restarting APT for patients who have previously experienced ICH may result in rebleeding events. The precise relationship between APT and ICH remains unknown. METHODS We searched PubMed for the most recent related literature and summarized the findings from various studies. The search terms included "antiplatelet," "intracerebral hemorrhage," "cerebral microbleeds," "hematoma expansion," "recurrent," and "reinitiate." Clinical studies involving human subjects were ultimately included and interpreted in this review, and animal studies were not discussed. RESULTS When individuals are administered APT, the risk of thrombotic events should be weighted against the risk of bleeding. In general, for some patients' concomitant with risk factors of thrombotic events, the advantages of antiplatelet medication may outweigh the inherent risk of rebleeding. However, the use of antiplatelet medications for other patients with a higher risk of bleeding should be carefully evaluated and closely monitored. In the future, a quantifiable system for assessing thrombotic risk and bleeding risk will be necessary. After evaluation, the appropriate time to restart APT for ICH patients should be determined to prevent underlying ischemic stroke events. According to the present study results and expert experience, most patients now restart APT at around 1 week following the onset of ICH. Nevertheless, the precise time to restart APT should be chosen on a case-by-case basis as per the patient's risk of embolic events and recurrent bleeding. More compelling evidence-based medicine evidence is needed in the future. CONCLUSION This review thoroughly discusses the relationship between APT and the development of ICH, the impact of APT on the course and prognosis of ICH patients, and the factors influencing the decision to restart APT after ICH. However, different studies' conclusions are inconsistent due to the differences in quality control. To support future clinical decisions, more large-scale randomized controlled trials are required.
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Affiliation(s)
- Yunjie Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xia Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyi Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaigai Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mena Romo L, Gómez-Choco M. Neuroimaging in small vessel disease. HIPERTENSION Y RIESGO VASCULAR 2023; 40:25-33. [PMID: 35676196 DOI: 10.1016/j.hipert.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
The objective of this article is to review the literature on neuroimaging in small vessel disease. A review was carried out through the Pubmed search engine, without a filter of years, using terms such as: cerebral small vessel disease; white matter hyperintensity; brain microbleed; WBC. Small vessel disease is the most common vascular pathology. Its basis is in the affectation of the small cerebral vessels that eventually causes an alteration in the blood-brain barrier. Its clinical implication is highly relevant. Using magnetic resonance imaging, different expressions of the disease have been observed, such as white matter hyperintensities, microbleeds or lacunar infarcts. Other more recent techniques, such as brain blood flow measurements, are helping to increase understanding of the pathophysiology of this disease.
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Affiliation(s)
- L Mena Romo
- Complex Hospitalari Despí Moisès Broggi, Servicio de Neurología, Spain.
| | - M Gómez-Choco
- Complex Hospitalari Despí Moisès Broggi, Servicio de Neurología, Spain
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Hong MP, Chen WF, Wu JH, Kang TS, He SP, Yang QW. Correlation between lipid-lowering therapy and cerebral microbleeds. Clin Hemorheol Microcirc 2023; 85:59-71. [PMID: 37355888 DOI: 10.3233/ch-231833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To investigate if there is a correlation between lipid-lowering treatment with statins and the occurrence, number, and location of cerebral microbleeds (CMBs) among patients with ischemic cerebrovascular disease (ICVD), and also to compare treatment with atorvastatin and rosuvastatin in terms of the occurrence of CMBs and their differences. METHODS In this retrospective study, we included patients who were diagnosed with ICVD and underwent susceptibility weighted imaging (SWI) in a grade A tertiary hospital from October 1, 2014 to October 1, 2022. We collected information on previous statin use, past medical history, clinical test indicators, and imaging data. RESULTS We found that out of 522 patients, 310 patients (59.4%) had no CMB and 212 patients (40.6%) had CMBs. There was no statistically significant correlation between prior statin use, the occurrence, and number of CMBs in patients diagnosed with ICVD (P < 0.05). As for the location of CMB, there was a statistically significant correlation between prior statin use and lobar CMBs (P < 0.048). However, there was no statistically significant correlation between the use of atorvastatin and rosuvastatin and the occurrence of CMBs (P > 0.05). CONCLUSION There was no independent correlation between previous statin use, and the occurrence, and number of CMBs in patients with ICVD. As for CMBs in different locations, there was a correlation between previous use of statin and lobar CMBs. There was no significant difference between atorvastatin and rosuvastatin in the occurrence of CMBs in patients with ICVD.
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Affiliation(s)
- Miao-Ping Hong
- Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei-Fen Chen
- Department of Neurology, First Hospital of Nanping City, Nanping, China
| | - Jie-Hao Wu
- Department of Neurology, Affiliated Hospital of Putian University, Putian, China
| | - Tai-Shan Kang
- Department of Radiology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shun-Po He
- Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Qing-Wei Yang
- Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Association between antiplatelet medication and cerebral microbleeds in stroke-free population. J Geriatr Cardiol 2022; 19:409-417. [PMID: 35845161 PMCID: PMC9248274 DOI: 10.11909/j.issn.1671-5411.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebral microbleeds (CMBs) may increase the risk of future intracerebral hemorrhage and ischemic stroke. However, It is unclear whether antiplatelet medication is associated with CMBs. This study aimed to investigate the association between antiplatelet medication and CMBs in a community-based stroke-free population. METHODS In this cross-sectional study, stroke-free participants aged 18-85 years were recruited from a community in Beijing, China. Demographic, clinical, and antiplatelet medication data were collected through a questionnaire, and all participants underwent blood tests and brain magnetic resonance imaging at 3.0T. The presence, count, and location of CMBs were evaluated using susceptibility-weighted imaging. The association between antiplatelet medication and the presence of CMBs was analyzed using multivariable logistic regression. The associations between antiplatelet medication and CMBs by location (lobar, deep brain or infratentorial, and mixed regions) were also analyzed using multinomial logistic regression. A linear regression analysis was conducted to determine the association between antiplatelet medication and the log-transformed number of CMBs. RESULTS Of the 544 participants (mean age: 58.65 ± 13.66 years, 217 males), 119 participants (21.88%) had CMBs, and 64 participants (11.76%) used antiplatelet medication. Antiplatelet medication was found to be associated with CMBs at any location [odds ratio (OR) = 2.39, 95% CI: 1.24-4.58] and lobar region (OR = 2.83, 95% CI: 1.36-5.86), but not with the number of CMBs (β = 0.14, 95% CI: -0.21-0.48). Among antiplatelet medications, aspirin use was found to be associated with any CMB (OR = 3.17, 95% CI: 1.49-6.72) and lobar CMBs (OR = 3.61, 95% CI: 1.57-8.26). CONCLUSIONS Antiplatelet medication was associated with CMBs in stroke-free participants, particularly lobar CMBs. Among antiplatelet medications, aspirin use was associated with any CMB and lobar CMBs. Our findings suggest that it might be essential to optimize the management of antiplatelet medication in the stroke-free population with a higher burden of vascular risk factors to reduce the potential risk of CMBs.
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Feng X, Tang Q, Cheng C, Xu S. Low serum lipid levels, use of statin and cerebral microbleeds: A systematic review and meta-analysis. J Clin Neurosci 2021; 94:216-225. [PMID: 34863441 DOI: 10.1016/j.jocn.2021.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/23/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous studies have shown that low serum lipids and statins may be related to cerebral hemorrhage. We made the meta-analysis to evaluate the associations between serum lipid levels or statins treatment and cerebral microbleeds (CMBs) to identify whether the similar correlation also existed. METHOD We comprehensively searched the Medline, Embase, Cochrane library, Web of Science, only included English journal articles, and systematically collected the observational studies and randomized controlled trials (RCTs) from September 1975 to August 2021. Random-effects model was used to pool data. Statistical heterogeneity was assessed by I2 statistic and chi-square. 11 items checklists recommended by the Agency for Healthcare Research and Quality (AHRQ), Newcastle-Ottawa Scale (NOS), and Cochrane Risk of Bias tool (ROB) were used to evaluate the methodological quality of cross-sectional studies, cohort studies and randomized controlled trial, respectively. RESULTS Five cohort studies, two RCTs, and ten cross-sectional studies, including 16,637 subjects and 2663 CMBs patients, were included in our quantitative synthesis. Our study found that after adjusting the covariates, total cholesterol (TC) was significantly inversely correlated with the prevalent CMBs in any location, while total triglycerides (TG) and High-density lipoprotein (HDL) were significantly inversely associated with prevalent deep CMBs. Low-density lipoprotein (LDL) was negatively associated with incident CMBs after adjusted confounders. We did not found statistical differences between statin and CMBs after adjusted covariates. CONCLUSION Serum major lipid (TC TG HDL LDL) levels may be inversely associated with CMBs. Currently, no sufficient evidence proves that statin therapy is the risk factor of CMBs.
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Affiliation(s)
- Xiao Feng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoqiao Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Cheng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Baang HY, Sheth KN. Stroke Prevention After Intracerebral Hemorrhage: Where Are We Now? Curr Cardiol Rep 2021; 23:162. [PMID: 34599375 DOI: 10.1007/s11886-021-01594-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Patients after intracerebral hemorrhage (ICH) are at high risk of both ischemic stroke and recurrent ICH, and stroke prevention after ICH is important to improve the long-term outcomes in this patient population. The objective of this article is to review the current guidelines on stroke prevention measures after ICH as well as the new findings and controversies for future guidance. RECENT FINDINGS Intensive blood pressure reduction might benefit ICH survivors significantly. Cholesterol levels and the risk of ICH have an inverse relationship, but statin therapy after ICH might be still beneficial. Anticoagulation in atrial fibrillation after ICH specifically with novel oral anticoagulants may be associated with better long-term outcomes. Left atrial appendage occlusion may be an alternative for stroke prevention in ICH survivors with atrial fibrillation for whom long-term anticoagulation therapy is contraindicated. While complete individualized risk assessment is imperative to prevent stroke after ICH, future research is required to address current controversies and knowledge gap in this topic.
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Affiliation(s)
- Hae Young Baang
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine & Yale New Haven Hospital, 15 York Street, Building LLCI, 10thFloor Suite 1003, P.O. Box 20818, New Haven, CT, 06520, USA.
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine & Yale New Haven Hospital, 15 York Street, Building LLCI, 10thFloor Suite 1003, P.O. Box 20818, New Haven, CT, 06520, USA
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Affiliation(s)
- Jose Gutierrez
- From the Department of NeurologyColumbia University Irving Medical CenterNew YorkNY
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Sharma R, Matsushita K, Wu A, Jack CR, Griswold M, Mosley TH, Fornage M, Gottesman RF. Common Medications and Intracerebral Hemorrhage: The ARIC Study. J Am Heart Assoc 2021; 10:e014270. [PMID: 33586464 PMCID: PMC8174245 DOI: 10.1161/jaha.120.014270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/23/2020] [Indexed: 01/28/2023]
Abstract
Background Antiplatelets, anticoagulants, and statins are commonly prescribed for various indications. The associations between these medications and the risk of intracerebral hemorrhage (ICH) and cerebral microbleeds (CMBs) are unclear. Methods and Results We performed a retrospective study of the ARIC (Atherosclerosis Risk in Communities) study cohort, recruited from 4 US communities in 1987 to 1989 with follow-up. In 2011 to 2013, a subset (N=1942) underwent brain magnetic resonance imaging with CMB evaluation. Time-varying and any antiplatelet, anticoagulant, or statin use was evaluated at subsequent study visits in participants not on each medication at baseline. To determine the hazard of ICH and odds of CMB by medication use, logistic and Cox proportional hazard models were built, respectively, adjusting for the propensity to take the medication, concomitant use of other medications, and cognitive, genetic, and radiographic data. Of 15 719 individuals during up to 20 years of follow-up, 130 participants experienced an ICH. The adjusted hazard of ICH was significantly lower among participants taking an antiplatelet at the most recent study visit before ICH versus nonusers (hazard ratio [HR], 0.53; 95% CI, 0.30-0.92). Statin users had a significantly lower hazard of an ICH compared with nonusers (adjusted HR, 0.13; 95% CI, 0.05-0.34). There was no association of CMB and antiplatelet, anticoagulant, or statin use in adjusted models. Conclusions In this US community-based study, antiplatelet and statin use were associated with lower ICH hazard, whereas no association was noted between CMBs and antiplatelets, anticoagulants, and statins. Further study is needed to understand the differential roles of these medications in cerebral microhemorrhages and macrohemorrhages.
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Affiliation(s)
- Richa Sharma
- Department of NeurologyYale University School of MedicineNew HavenCT
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Aozhou Wu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michael Griswold
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Myriam Fornage
- Institute of Molecular MedicineUniversity of Texas at HoustonTX
| | - Rebecca F. Gottesman
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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