Association of prothrombotic status with markers of cerebral small vessel disease in elderly hypertensive patients

Background Aging and hypertension are well-known risk factors for cerebral white matter lesions. Prothrombotic status has been shown to be a risk factor for cardiovascular disease. In this study, we investigated the relationships among prothrombotic status, ambulatory blood pressure (ABP), and white matter hyperintensity (WMH) in elderly hypertensives.MethodsMeasurement of prothrombin fragments 12 (F1+2), von Willebrand Factor (vWF) and plasminogen activator inhibitor-1 (PAI-1), ABP monitoring (ABPM), and brain magnetic resonance imaging (MRI) were performed in 514 Japanese elderly hypertensives (72.3 years old, male 37%). WMH cases were further divided into deep subcortical white matter lesion (DWML) or periventricular hyperintensity (PVH).ResultsDeep WMH (DWMH) had significant positive correlations with age, use of antiplatelet agents, log F1+2, log vWF, log PAI-1, and 24-h systolic BP (SBP). PVH had significant positive correlations with age, male gender, smoking, use of antiplatelet agents, white coat hypertension (WCH), log vWF, and 24-h SBP. Severe PVH had significant positive correlations with age, use of antiplatelet agents, WCH, and 24-h SBP, and that was marginally correlated with log F12. In the logistic linear regression analysis, log F12 was significantly associated with DWMH (P< 0.01) and severe PVH (P< 0.05) adjusted for age and 24-h SBP. Log PAI-1 was significantly associated with DWMH (P <0.05) adjusted for age and 24-h SBP.ConclusionsIn the present study, F12 and PAI-1 were positively associated with WMH after adjustment for 24-h SBP in elderly hypertensives. In addition to the conventional risk factors, prothrombotic status might serve as a significant determinant for WMH.