Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions

Jan Willem Van Dalen*, Eric P. Moll Van Charante, Matthan W.A. Caan, Philip Scheltens, Charles B.L.M. Majoie, Aart J. Nederveen, Willem A. Van Gool, Edo Richard

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background and Purpose - This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension. Methods - The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure ≥140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation. Results - One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; P=0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes (P for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; P=0.36). Conclusions - Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low.

Original languageEnglish
Pages (from-to)1842-1848
Number of pages7
JournalStroke
Volume48
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Cite this

Van Dalen, J. W., Moll Van Charante, E. P., Caan, M. W. A., Scheltens, P., Majoie, C. B. L. M., Nederveen, A. J., ... Richard, E. (2017). Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions. Stroke, 48(7), 1842-1848. https://doi.org/10.1161/STROKEAHA.117.017207