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Cerebral small vessel disease, systemic vascular characteristics and potential therapeutic targets
Salim Elyas1,2, Damilola Adingupu1, Kunihiko Aizawa1
1Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter EX2 5AX, UK.
Insights
Cerebral small vessel disease (SVD) is common in older adults. This study identified arterial stiffness, vascular reactivity, and cerebrovascular resistance as potential targets for treating SVD and preventing dementia and stroke.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Geriatrics
Background:
- Cerebral small vessel disease (SVD) is a significant cause of dementia, stroke, and disability in the elderly.
- Current treatment strategies for cerebral SVD are limited, necessitating the identification of modifiable targets.
Purpose of the Study:
- To identify modifiable vascular targets for the treatment and prevention of cerebral SVD.
Main Methods:
- 112 participants underwent comprehensive vascular function tests (macrovascular, microvascular, endothelial) and MRI brain scans.
- Analysis included associations between vascular parameters, white matter hyperintensities (WMH) severity, and risk factors.
Main Results:
- Arterial stiffness (carotid intima-media thickness, pulse wave velocity) and microvascular reactivity were associated with cerebral WMH severity.
- Cerebral resistance index, flow-mediated dilation, ankle-brachial index, and albuminuria also predicted WMH severity.
- Hypertension and age were the strongest predictors of WMH severity.
Conclusions:
- Beyond hypertension, microalbuminuria, arterial stiffness, vascular reactivity, and cerebrovascular resistance are potential therapeutic targets.
- Targeting these factors may help halt the progression of cerebral SVD and reduce associated risks.
Introduction:
Cerebral small vessel disease (SVD) is prevalent in the elderly population and is associated with increased risk of dementia, stroke and disability. Currently there are no clear targets or strategies for the treatment of cerebral SVD. We set out to identify modifiable vascular treatment targets.
Patients And Methods:
112 participants with and without a history of CVD underwent macrovascular, microvascular and endothelial function tests and an MRI head scan.
Results:
Increased carotid intima media thickness and carotid-femoral pulse wave velocity were associated with cerebral WMH (β=1·1 p=0·001 and β=1·66, p<0·0001 respectively). Adjusted cerebral resistance index (p=0·03) and brachial flow mediated dilation time to peak (p=0·001) were associated with the severity of cerebral WMH independent of age and sex. Post occlusive reactive hyperaemia time as a measure of microvascular reactivity was associated with WMH after adjustment for age and sex (p=0·03). Ankle Brachial Pressure Index and urinary albumin excretion rate predicted the severity of cerebral WMH (p=0·02 and 0·01 respectively). Age and hypertension were the most important risk factors for WMH severity (p< 0·0001).
Discussion:
In addition to hypertension, microalbuminuria, arterial stiffness, vascular reactivity and cerebrovascular resistance could be potential treatment targets to halt the development or progression of cerebral SVD.
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