Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly

Background and Purpose-MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with c ognitive impairment and dementia. A relation between atherosclerosis and wh ite matter lesions was found in some small cross-sectional studies, However , atherosclerosis is a gradual process that starts early in life. We invest igated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions. Methods-We randomly sampled subjects between 60 and 90 years old from 2 pop ulation-based follow-up studies in which subjects had their baseline examin ations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 t o 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were ra ted in the deep subcortical and periventricular regions separately, Aortic atherosclerosis was assessed on abdominal radiographs that were obtained fr om 276 subjects in midlife and 531 subjects in late life. Results-The presence of aortic atherosclerosis during midlife was significa ntly associated with the presence of periventricular white matter lesions a pproximate to 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5 .0); the relative risks increased linearly with the severity of aortic athe rosclerosis. No association was found between midlife aortic atherosclerosi s and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI , 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions, Conclusions-The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife, The critical per iod for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.