Cerebral white matter lesions predict both ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease

Background: Cerebral white matter lesions (WML) are regarded as manifestations of small vessel disease, but have also been associated with large vessel atherosclerosis. We investigated whether WML have a predictive value for future ischemic events. Methods and results: Two-hundred-thirty patients with proven atherosclerotic disease, recent ischemic stroke (IS, n = 70), recent myocardial infarction (MI, n = 71), or peripheral arterial disease (PAD, n = 89) were included. The presence of periventricular lesions (PVL) and deep white matter lesions (DWML) on MRI at entry and ischemic events during follow-up were registered. During follow-up with a mean duration of 3.5 +/- 1.4 years 22 patients had a MI, 21 patients suffered an IS and 2 patients died suddenly. The frequency of ischemic events during follow-up was higher among patients with PVL than in those without PVL (IS: 18% versus 5%, p = 0.001; ME 15% versus 7%, p = 0.03; any ischemic event: 36% versus 11 %, p < 0.001). DWML was associated only with the combined outcome any ischemic event (P = 0.04). In multivariate regression analysis the presence of PVL was independently associated with IS (HR 3.2 (95%CI 1.3-8.4) and MI (HR 3.4 (95%CI 1.4-8.0)). Conclusion: We observed an association between WML, especially PVL, and future ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease. (c) 2005 Published by Elsevier Ireland Ltd.