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Age related white matter changes predict stroke death in long term follow-up
  1. N K J Oksala1,2,
  2. A Oksala2,
  3. T Pohjasvaara3,
  4. R Vataja4,
  5. M Kaste3,
  6. P J Karhunen2,
  7. T Erkinjuntti3
  1. 1
    Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Finland
  2. 2
    School of Medicine, Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Finland
  3. 3
    Department of Neurology, Helsinki University Central Hospital, Finland
  4. 4
    Department of Neuropsychiatry and Psychogeriatrics, Kellokoski Hospital, Finland
  1. Dr N Oksala, Department of Surgery and Forensic Medicine, Medical School, University of Tampere and Tampere University Hospital, 33014 University of Tampere, Finland; niku.oksala{at}


Objective: Recurrent strokes and functional decline are predicted by age related white matter changes (ARWMC). Whether they are associated with long term survival among hospital patients referred for acute stroke is not known.

Methods: A total of 396 consecutive acute stroke patients subjected to MRI were included in the study and followed-up for up to 12 years.

Results: 28% had mild, 18% had moderate and 54% had severe ARWMCs. In Kaplan–Meier analysis, poor survival was predicted by severe ARWMCs (p<0.0001), cardiac failure (CF, p<0.0001), atrial fibrillation (AF, p<0.0001), other arrhythmias (p = 0.003), peripheral arterial disease (PAD, p = 0.004) and poor modified Rankin score (mRS) (p<0.0001). ARWMC was related to death by all brain related causes, especially ischaemic stroke (p<0.0001). In stepwise Cox regression analysis adjusted with significant risk factors, severe ARWMCs (hazard ratio (HR) 1.34, 95% CI 1.03 to 1.73; p = 0.029), age (HR 1.07, 95% CI 1.05 to 1.09; p<0.0001), CF (HR 1.59, 95% CI 1.17 to 2.15; p = 0.003), AF (HR 1.68, 95% CI 1.24 to 2.27; p = 0.001), PAD (HR 1.59, 95% CI 1.11 to 2.26; p = 0.011), diabetes (HR 1.44, 95% CI 1.08 to 1.92; p = 0.013), smoking (HR 1.60, 95% CI 1.23 to 2.08; p<0.0001) and mRS (HR 1.65, 95% CI 1.26 to 2.14; p<0.0001) were independently associated with death from all causes. Severe ARWMCs (HR 1.80, 95% CI 1.10 to 2.96; p = 0.019), age (HR 1.05, 95% CI 1.01 to 1.09; p = 0.009), AF (HR 1.82, 95% CI 1.08 to 3.07; p = 0.026), PAD (HR 2.17, 95% CI 1.19 to 3.95; p = 0.012) and mRS (HR 2.75, 95% CI 1.67 to 4.54; p<0.0001) were specifically associated with death from brain related causes.

Conclusions: In patients with acute stroke, ARWMC seems to be a significant predictor of poor long term survival and death by ischaemic stroke.

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  • Competing interests: None.

  • Funding: This study was supported by grants from the Maire Taponen Foundation; the Paavo Nurmi Foundation; The Finnish Angiologic Association; the Medical Council of the Academy of Finland (Helsinki); the Clinical Research Institute, Helsinki University Central Hospital; the Yrjö Jahnsson Foundation (Helsinki); the Finnish Cultural Foundation and the Elli and Elvi Oksanen Fund of the Pirkanmaa Fund under the auspices of the Finnish Cultural Foundation (Tampere); the Medical Research Fund of Tampere University Hospital; the Finnish Medical Foundation; and the Finnish Foundation for Cardiovascular Research (Helsinki).

  • Ethics approval: The study was approved by the Helsinki University Hospital Ethics Committee.