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Background/Objective: White matter hyperintensities (WMH) are frequently observed in adults without atherosclerotic cardiovascular disease (ASCVD), yet antiplatelet agents are often prescribed empirically. We aimed to explore whether antiplatelet treatment is associated with stroke prevention in this specific population. Methods: This retrospective analysis used prospectively collected data from adults undergoing regular health examinations (2011–2019). We assessed associations between antiplatelet use and stroke outcomes according to WMH Fazekas (1–3) and cerebral small-vessel disease (cSVD) scores (0–4). The primary outcomes were stroke of any type, ischemic stroke, and hemorrhagic stroke. Results: Among 1672 participants (mean age 57.1 ± 8.5 years; 15.6% on antiplatelets), 28 (1.7%) strokes of any type, 26 (1.6%) ischemic strokes, and 2 (0.2%) hemorrhagic strokes occurred during a mean 3.5-year follow-up. The risk of any stroke was higher in those with cSVD scores 3–4 compared to score 0 (adjusted HR 8.45; 95% CI 1.53–46.53). WMH severity was not independently related to increased risk of any outcome events. The relative risk of those with cSVD scores 3–4 for stroke of any type and ischemic stroke was not different across subgroups stratified by antiplatelet use (all Pinteraction > 0.05). Post hoc power analysis showed 0.12 power for both strokes of any type and ischemic strokes. Conclusions: While cSVD score may help identify higher stroke risk, our findings suggest that antiplatelet agents might not provide significant additional benefit for stroke prevention in ASCVD-naïve adults. These results should be considered hypothesis-generating, emphasizing the need for careful risk factor management over empirical antiplatelet prescription.
Kim et al. (Tue,) studied this question.