Cerebral Microbleeds as Predictors of Mortality: The Framingham Heart Study

José R. Romero, Sarah R. Preis, Alexa Beiser, Jayandra J. Himali, Ashkan Shoamanesh, Philip A. Wolf, Carlos S. Kase, Ramachandran S. Vasan, Charles Decarli, Sudha Seshadri

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background and Purpose - Cerebral microbleeds (CMB) represent a common magnetic resonance imaging marker of cerebral small vessel disease, increasingly recognized as a subclinical marker of stroke and dementia risk. CMB detection may reflect the cumulative effect of vascular risk burden and be a marker of higher mortality. We investigated the relation of CMB to risk of death in community dwelling participants free of stroke and dementia. Methods - We evaluated 1963 Framingham Original and Offspring Cohort participants (mean age 67 years; 54% women) with available brain magnetic resonance imaging and mortality data. Using Cox proportional hazards models, we related CMB to all-cause, cardiovascular, and stroke-related mortality. Results - Participants with CMB (8.9%) had higher prevalence of cardiovascular risk factors and use of preventive medications. During a mean follow-up of 7.2±2.6 years, we observed 296 deaths. In age- and sex-adjusted analysis, CMB were associated with increased all-cause mortality (hazards ratio, 1.39; 95% confidence interval 1.03-1.88), a relation that was no longer significant after adjustment for cardiovascular risk and preventive medication use (hazards ratio, 1.15; 95% confidence interval, 0.82-1.63). Conclusions - CMBs may represent the deleterious effect of cardiovascular risk factors in the cerebral vasculature. Although their presence was associated with increased all-cause mortality, the effect was no longer present after accounting for vascular risk factors and preventive treatment use. Further studies are required to clarify the role of cardiovascular preventive therapies for prevention of mortality in persons with incidental detection of CMB.

Original languageEnglish (US)
Pages (from-to)781-783
Number of pages3
Issue number3
StatePublished - Mar 1 2017
Externally publishedYes


  • cerebral microbleed
  • cerebral small vessel disease
  • community
  • epidemiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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