Association of exhaled carbon monoxide with stroke incidence and subclinical vascular brain injury

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The negative article here:

Association of exhaled carbon monoxide with stroke incidence and subclinical vascular brain injury

Stroke, 02/12/2016Nayor M, et al.

The authors related exhaled carbon monoxide (CO) to magnetic resonance imaging measures of subclinical cerebrovascular disease cross–sectionally and to incident stroke/transient ischemic attack prospectively in the Framingham Offspring study. In this large, community–based sample of individuals without clinical stroke/transient ischemic attack at baseline, higher exhaled CO was associated with a greater burden of subclinical cerebrovascular disease cross–sectionally and with increased risk of stroke/transient ischemic attack prospectively. Further investigation is necessary to explore the biological mechanisms linking elevated CO with stroke.

Methods

• The authors measured exhaled CO in 3313 participants (age 59±10 years; 53% women), and brain magnetic resonance imaging was available in 1982 individuals (age 58±10 years; 54% women).
• Participants were analyzed according to tertiles of exhaled CO concentration.

Results

• In age- and sex-adjusted models, the highest tertile of exhaled CO was associated with lower total cerebral brain volumes, higher white-matter hyperintensity volumes, and greater prevalence of silent cerebral infarcts (P<0.05 for all).
• The results for total cerebral brain volume and white-matter hyperintensity volume were consistent after removing smokers from the sample, and the association with white-matter hyperintensity volume persisted after multivariable adjustment (P=0.04).
• In prospective analyses (mean follow-up 12.9 years), higher exhaled CO was associated with 67% (second tertile) and 97% (top tertile) increased incidence of stroke/transient ischemic attack relative to the first tertile that served as referent (P<0.01 for both).
• These results were consistent in nonsmokers and were partially attenuated upon adjustment for vascular risk factors.

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