Relation of Antiphospholipid Antibodies to Postmortem Brain Infarcts in Older Persons
Background—There are little data on the relationship of antiphospholipid antibodies (aPL) to pathologically-proven brain infarcts. We tested the hypothesis that aPL are associated with a higher odds of brain infarcts among older, community-dwelling persons who came to autopsy.
Methods and Results—Specimens, and clinical and pathologic data, were derived from 607 deceased subjects (mean age-at-death = 89 years, 66% women) who were participating in one of two cohort studies of aging (Rush Memory and Aging Project; Religious Orders Study) and had agreed to brain autopsy. Brain infarcts were identified on gross and microscopic examinations, and severity of cerebral vessel disease (atherosclerosis, arteriolosclerosis) was graded. Four clinically-used aPL were measured longitudinally: three in serum (anticardiolipin antibodies, β2-glycoprotein I, and antiphosphatidyl-serine), and one in plasma (lupus anticoagulant). A quarter of subjects (142/607, 23%) had at least one aPL present at baseline (median time interval from baseline to death =4.6 years), and three-quarters of these had persistently positive measures over time. In a logistic regression analysis, baseline aPL positivity did not increase the odds of brain infarcts (OR =1.08; 95% CI: 0.74, 1.58; p=0.19), or of gross or microscopic infarcts separately. Findings were essentially unchanged when considering number of baseline aPL, aPL proximate to death, and persistence of aPL. Associations did not differ among subjects with increased severity of vessel disease.
Conclusions—Overall, we did not find evidence that aPL increase the odds of pathological brain infarcts in older persons.
- Received July 25, 2014.
- Revision received September 25, 2014.
- Accepted October 6, 2014.