Asymptomatic Coronary Plaque Linked to White Matter Lesions

Asymptomatic Coronary Plaque Linked to White Matter Lesions

Nancy A. Melville 

October 28, 2019

ST. LOUIS — The presence of coronary artery atherosclerotic plaque is significantly associated with increased white matter hyperintensity volume in the brain — specifically the periventricular region, new research suggests. This occurs even in healthy individuals who are at risk for coronary artery disease(CAD) but are asymptomatic.

Using data from the ongoing Genetic Study of Atherosclerosis Risk (GeneSTAR) study, the results suggest that CAD may also “have differential associations with lesions in different locations,” the investigators note.

“Our findings are novel because they consider the different locations of the white matter disease, which has not been done before; and our cohort is also unique,” lead author Michelle C. Johansen, MD, from Johns Hopkins University School of Medicine, Baltimore, Maryland, told Medscape Medical News.

“The GeneSTAR cohort enables us to look at younger individuals who have a family history of CAD but no manifestations of disease,” Johansen added.

The findings were presented here at ANA 2019: 144th Annual Meeting of the American Neurological Association.

Unknown Mechanisms 

White matter hyperintensity, or lesions, has increasingly been shown to be associated with cognition as well as overall function. Although CAD is known to be linked with white matter lesions, understanding of mechanisms and significance of location in the brain is lacking.

To evaluate these issues, the investigators turned to GeneSTAR, an ongoing prospective study designed to identify genetic and biological risk factors in families with early-onset CAD.

They identified 782 asymptomatic individuals who had family members with premature CAD, meaning they were younger than the age of 60 years. These participants (58% women; 39% black; mean age, 51 years) were eligible for coronary computed tomography angiography (CTA) and brain MRI.

Analyzing biomarkers of CAD and MRI, and after controlling for traditional risk factors such as hypertension and diabetes, the researchers found a significant association between CAD atherosclerotic plaque volume and white matter hyperintensity. In fact, there was an increase in total white matter hyperintensity volume of 0.08% for each 1% increase in total cardiac plaque volume (95% confidence interval [CI], 0.05 – 0.11).

Participants showing any coronary plaque had white matter hyperintensity volumes that were as much as 58% greater than those without any plaque (β, 0.46; 95% CI, 0.28 – 0.63).

Looking at the specific location of hyperintensities, the researchers found that for each 1% increase in total cardiac plaque there was a 5.0% larger deep white matter hyperintensity (95% CI, 4.66 – 5.42), a 5.1% increase in periventricular white matter hyperintensity volume (95% CI, 4.71 – 5.51), and a 2.75% greater cuff volume.

Compared with the other regions, periventricular white matter hyperintensity volume was significantly greater than cuff volume (P < .001) and deep white matter hyperintensity (P = .001).