Relationship between carotid arterial properties and cerebral white matter hyperintensities
Tatjana Rundek1, David Della-Morte2, Hannah Gardener1
1From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis.
Objective:
Since arterial stiffness is a functional measure of arterial compliance and may be an important marker of cerebrovascular disease, we examined the association of carotid artery stiffness with white matter hyperintensity volume (WMHV) in a cross-sectional study of 1,166 stroke-free participants.
Methods:
Carotid beta stiffness index (STIFF) was assessed by M-mode ultrasound of the common carotid artery and calculated as the ratio of natural log of the difference between systolic and diastolic blood pressure over STRAIN, a ratio of the difference between carotid systolic and diastolic diameter (DD) divided by DD. WMHV was measured by fluid-attenuated inversion recovery MRI. The associations of STIFF, DD, and STRAIN with WMHV were examined using linear regression after adjusting for sociodemographic, lifestyle, and vascular risk factors.
Results:
In a fully adjusted model, larger carotid DD was significantly associated with greater log-WMHV (β = 0.09, p = 0.001). STIFF and STRAIN were not significantly associated with WMHV. In adjusted analyses stratified by race-ethnicity, STRAIN (β = -1.78, p = 0.002) and DD (β = 0.11, p = 0.001) were both associated with greater log-WMHV among Hispanic participants, but not among black or white participants.
Conclusions:
Large carotid artery diameters are associated with greater burden of white matter hyperintensity (WMH) in this multiethnic population. The association between increased diameters, decreased STRAIN, and greater WMH burden is more pronounced among Hispanics. These associations suggest a potential important pathophysiologic role of extracranial large artery remodeling in the burden of WMH.
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