Abstract 17265: The Relationship Between Subclinical Coronary Artery Atheroscelrosis and Brain Ischemic White Matter Disease in Healthy Individuals from High Risk Families
Background: Ischemic white matter disease (IWMD) is associated with incident stroke. Similarly subclinical coronary artery disease is associated with incident coronary artery disease (CAD) events. Although, atherogenesis in both vascular beds likely shares common mechanisms, the extent to which subclinical CAD is associated with preclinical IWMD in a young to middle-aged healthy asymptomatic high risk population with a family history of premature CAD remains unknown.
Methods: We screened 405 apparently healthy participants in Genetic Study of Atherosclerotic Risk (GeneSTAR) (mean age 51.6 ± 10.6 years, 60% female, 36% African American) for CAD risk factors, and for the presence of calcified and noncalcified coronary plaque using dual-source 256 multi-detector cardiac CT angiography. The presence of IWMD was assessed by 3 Tesla brain MRI and the ischemic white-matter volume to brain volume (WVBV) ratio was calculated using direct measurements. A multivariate linear regression analysis predicting WVBV was performed for the presence of CAD, adjusting for age, sex, race, traditional CAD risk factors, and intrafamilial correlations using a generalized estimating equation (GEE).
Results: Subclinical CAD was highly prevalent (43.0%). Individuals with coronary plaque had a higher ratio of WVBV (median 0.11, interquartile range [0.04 to 0.33]) as compared to those without coronary plaque (median 0.05 [0.01 to 0.14], p<0.001). In the fully adjusted analysis, the presence of subclinical CAD was a significant predictor of WVBV (p=0.05), as was age (p<0.001).
Conclusion: This is the first study to show a strong association of subclinical CAD and occult ischemic white mater disease in healthy high-risk young to middle aged individuals, independent of traditional CAD risk factors, including age. The findings support the premise of shared causal pathways in the two vascular beds in families at increased risk for both CAD and stroke.
- © 2011 by American Heart Association, Inc.