Smoking is associated with silent cerebrovascular disease in a high-risk Japanese community-dwelling population

Abstract

We aimed to investigate the relationships between smoking and silent cerebrovascular damage. We performed brain MRI to evaluate silent cerebral infarct (SCI) and periventricular hyperintensity (PVH), and carotid-ultrasonography to investigate carotid atherosclerotic plaque in 170 high-risk community-dwelling subjects (mean age: 67.2 years; men: 28.7%) who met more than 3 of the following 9 criteria: 1) high blood pressure (BP); 2) hypercholesterolemia; 3) left ventricular hypertrophy; 4) high hemoglobin A1c; 5) proteinuria; 6) high waist-to-hip ratio; 7) smoking ≥30 cigarettes/day; 8) heavy alcohol intake; 9) family history of stroke. The subjects with SCI (SCI group) were older (70 years vs. 66 years, p=0.004) and had higher systolic BP (SBP) (160 vs. 148 mmHg, p<0.001) and higher carotid plaque score (2.3 vs. 1.5/person, p< 0.05) than those without SCI. Among the variables, smoking status (r=0.34, p<0.001), SBP (r=0.28, p<0.001), male gender (r=0.29, p<0.001), left ventricular mass index (r=0.25, p=0.001), and serum creatinine (r= 0.20, p=0.006) were significantly correlated with the number of SCIs. Among smokers, the number of SCIs was significantly higher in current smokers than in past smokers (1.9±2.2 vs. 0.5±0.8, p< 0.01). In multiple regression analysis, smoking status (β=0.183, p=0.045) and SBP (β=0.196, p=0.011) were independent determinants of the increased number of SCIs. In conclusion, smoking status was an independent determinant of multiple SCIs in a high-risk Japanese community-dwelling population.