Different patterns of silent cerebral infarct in patients with coronary artery disease or hypertension

The aim of the present study was to clarify the differences in the progress ion and the characteristics of silent cerebral infarcts (SCI) between patie nts with coronary artery disease (CAD) and hypertensive patients. Silent ce rebral infarcts, a powerful prognostic indicator for stroke, are frequently found in patients with CAD and in hypertensives. However, the differences in the characteristics of SCI and related risk factors between CAD and hype rtensive patients have not been thoroughly investigated. We evaluated the n umber of SCI and their distribution using brain magnetic resonance imaging (T1- and T2-weighted images) in 107 patients with CAD (validated by coronar y angiography) and 101 hypertensive patients without history of clinical st roke. The prevalence of multiple SCI (three or more infarcts per person) in patients with CAD and with hypertension was significantly higher than in h ypertensives without CAD (46% v 21%; P = .001), whereas that of patients wi th CAD without hypertension was intermediate (31%). The patients with multi - (two- or three-vessel) vessel diseases (VD) had a significantly higher pr evalence of multiple SCI than the hypertensives and the no-stenosis or 1-VD group (68.1% in the 3-VD group, 52.0% in the 2-VD group, 26.8% in the I-VD group, and 21.0% in the no-stenosis group). Multiple logistic regression a nalysis revealed that in the CAD group, the number of involved coronary art eries was an independent determinant of SCI (P < .005), whereas in the hype rtensive group, age was an independent determinant of SCI (P < .005). When we investigated the distribution of SCI, in the CAD group, SCI in the deep perforator territory (the basal ganglia and the thalamus) were independentl y associated with the number of involved coronary arteries (P < .005), wher eas SCI in the white matter were independently associated with age only (P < .005). In conclusion, SCI were more advanced in the patients with multive ssel CAD than in the hypertensive patients, and were more common in patient s with CAD and hypertension than in those without hypertension. Coronary at herosclerosis was independently and specifically associated with SCI locate d in the deep perferator territory but not of SCI located in the white matt er. The CAD-atherosclerosis and hypertension may be independently involved in the pathologic process of SCI. (C) 2001 American Journal of Hypertension , Ltd.