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; MI: 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.