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The Cardiovascular Health Study

W. T. Longstreth, Jr, MD, MPH; Charles Bernick, MD; Teri A. Manolio, MD, MHS; Nick Bryan, MD, PhD; Charles A. Jungreis, MD; Thomas R. Price, MD; for the Cardiovascular Health Study Collaborative Research Group

Arch Neurol. 1998;55:1217-1225.

Objective  To identify risk factors for and functional consequences of lacunar infarct in elderly people.

Methods  The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years or older, in which 3660 participants underwent cranial magnetic resonance imaging (MRI). Neuroradiologists read scans in a standard fashion without any clinical information. Lacunes were defined as subcortical areas consistent with infarcts measuring 3 to 20 mm. In cross-sectional analyses, clinical correlates were contrasted among groups defined by MRI findings.

Results  Of the 3660 subjects who underwent MRI, 2529 (69%) were free of infarcts of any kind and 841(23%) had 1 or more lacunes without other types present, totaling 1270 lacunes. For most of these 841 subjects, their lacunes were single (66%) and silent (89%), namely without a history of transient ischemic attack or stroke. In multivariate analyses, factors independently associated with lacunes were increased age, diastolic blood pressure, creatinine, and pack-years of smoking (listed in descending order of strength of association; for all, P<.005), as well as maximum internal carotid artery stenosis of more than 50% (odds ratio [OR], 1.81; P <.005), male sex (OR, 0.74; P <.005), and history of diabetes at entrance into the study (OR, 1.33; P <.05). Models for subgroups of single, multiple, silent, and symptomatic lacunes differed only minimally. Those with silent lacunes had more cognitive, upper extremity, and lower extremity dysfunction not recognized as stroke than those whose MRIs were free of infarcts.

Conclusions  In this group of older adults, lacunes defined by MRI are common and associated with factors that likely promote or reflect small-vessel disease. Silent lacunes are also associated with neurologic dysfunction.

From the Departments of Neurology and Epidemiology, University of Washington, Seattle (Dr Longstreth); the Department of Neurology, University of California, Davis (Dr Bernick); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio); Neuroradiology Division, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Md (Dr Bryan); the Departments of Radiology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (Dr Jungreis); and the Department of Neurology, University of Maryland, Baltimore (Dr Jungreis).

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