Having a history of heart failure (HF) is independently associated with white matter lesions (WML), according to new findings published in ESC Heart Failure. The findings, say the researchers, may pave the way for research into the prognostic value of WML in HF and the impact that HF therapies have on WML, as WML can have negative implications for cognitive and physical functioning.
The finding comes from the German population–based LIFE-Adult Study of 10,000 patients, 2500 of which underwent cerebral MRI and had WML measured by Fazekas score, which ranges from 0 to 3 based on the overall burden of a patient’s WML.
HF (odds ratio [OR], 2.8; 95% CIU, 1.2-6.5; P = .019) joined the ranks of older age (OR, 1.099; 95% CI, 1.078-1.120; P ≤ 0.001), hypertension (OR, 2.0; 95% CI, 1.5-2.8; P < . 001), and stroke (OR, 2.0; 95% CI, 1.0-4.1; P = .05) as being independently associated with WML. More than one-third (40%) of patients with HF had a WML Fazekas score of 2-3, indicating severe WML, compared with 15.1% of those without HF.
HF remained independently associated with WML even when including atrial fibrillation (AF) in the model. AF originally was flagged as being independently associated with WML in univariate analysis but was no longer independently associated after adjusting for age and gender. This remained true when including HF in the model.
“Contrary to our initial expectations, our results showed no association between AF and WML after adjustment for age, gender, stroke, and hypertension,” wrote the researchers. “WML may develop in AF by silent brain infarcts, mostly in patients not on anticoagulation.”
The findings also indicated that the duration of HF, not just the prevalence, has implications for WML. A HF duration of less than 3 years was associated with an OR of 0.8 (95% CI, 0.1-7.5), while having HF for 4 to 6 years was associated with an OR of 1.6 (95% CI, 0.3-9.6) and having HF for more than 6 years, an OR of 2.9 (95% CI, 1.1-7.9; P = .036).
Meanwhile, the risk of WML with hypertension was not impacted by the duration of the condition, with an OR of 2.0 (95% CI, 1.3-3.2; P = .002) for hypertension duration of less than 3 years, 2.2 (95% CI, 1.4-3.4; P < .001) for duration of 4 to 6 years, and 1.9 (95% CI, 1.4-2.6; P < .001)for duration of more than 6 years.
“Consistent with our findings, previous studies reported associations of increased systolic blood pressure and age with WML,” commented the researchers. “For instance, a previous study reported an increased risk for WML with longer duration of hypertension while we did not observe that the patients in the LIFE-Adult Study may had well-diagnosed and well-controlled hypertension, while poor control of blood pressure was associated with WML.”
Other factors, like gender, body mass index, myocardial infarction, and diabetes, were not associated with WML.
Stegmann T, Chu ML, Witte VA, et al. Heart failure is independently associated with white matter lesions: insights from the population-based LIFE-Adult Study. ESC Heart Fail. Published online December 15, 2020. doi:10.1002/ehf2.13166