Objective:

To evaluate the association between FSRP score and WML progression.

Background:

Studies have shown that Framingham stroke risk profile (FSRP) and white matter lesions (WML) are individually associated with the risk of cognitive decline. Whether FSRP score may be used to predict WML progression is not well studied.

Design/Methods:

Consecutive patients with two brain MRI examinations at least one year apart from a biomarker cerebrovascular registry 2010-2020 were included. The primary outcome was fast vs slow WML progression defined as annual change in WML volume (cm3/year) above vs below the median. Mini Mental State Exam (MMSE, 0-30) was used for cognition. FSRP score ranges from 0 to 8, calculated by adding the presence of each vascular risk factors: Age≥65yo, smoking, SBP>130mmHg, diabetes, coronary disease, atrial fibrillation, left ventricular hypertrophy, and use of antihypertensive medication. lesion predictive algorithm (LPA) was used to quantify WMLs volume. Logistic regression analyses were performed to evaluate the relationship between FSRP and WML progression and cognition.

Results:

Of the 207 patients, mean age was 60±16 years, 54.6% were women, and median time between MRI brain scans was 4.3 (1.3-11.8) years. The rate of WML progression was 0.9cm3 (IQR 0.1-3.1cm3) per year from a median baseline WMD volume of 9.6cm3 (IQR 3.3-28.4cm3). There were 22.6%, 40.7%, 36.8% patients with FSRP score 0-1, 2-3 and ≥4. FSRP was associated with fast WMD progression (OR 1.37, 95%CI 1.12-1.68, p=0.002) and lower MMSE (mean 23.3 vs 27, p=0.0007). There was dose-dependent relationship between having higher FSRP score and fast WML progression: OR 2.25, 5.54, 7.73, 8.32 across FSRP score 1, 2, 3 and ≥4 (trend p=0.002).

Conclusions:

We found that higher Framingham risk score was associated with WML progression and lower cognition, conferring targeted treatment of Framingham vascular risk factors may reduce the rate of WML progression.