Association Between Pulse Wave Velocity and Cerebral Small Vessel Disease: A Scoping Review

Cerebral small vessel disease (CSVD) is a common condition affecting the small vessels of the brain and is often linked to dementia and strokes. Its prevalence increases with age, making noninvasive predictors essential for early intervention and management. Arterial stiffness, commonly measured via pulse wave velocity (PWV), has been proposed as a marker of CSVD, but differences in PWV measurement methods, CSVD markers, and confounders such as age and vascular risk complicate this relationship. This scoping review aimed to clarify the association between PWV and CSVD by searching four databases (EMBASE, Ovid MEDLINE, Web of Science, and CINAHL) for peer-reviewed articles written in English published between 2014 and 2024 that included both PWV and at least one major CSVD biomarker: (1) white matter hyperintensities (WMH), (2) lacunar infarcts (LI), (3) fractional anisotropy (FA), (4) cerebral microbleeds (CMB), or (5) perivascular spaces (PVS). Of 1,345 articles initially identified, 53 met the inclusion criteria. The findings suggest a general trend of higher PWV being associated with increased WMH volume, greater PVS severity, decreased FA, and the presence of LI, with several studies also linking the CSVD-PWV association to cognitive decline, stroke recurrence, and depression. The most definitive associations were found between PWV and the presence of WMH. These findings support PWV's potential as an early predictor of CSVD severity and progression, provided that suitable standardization of measurement methods and further longitudinal research are done. The association between PWV and cognitive decline, stroke risk, and functional recovery further underscores PWV in a potential role as a predictive marker in CSVD management. Identifying PWV as a modifiable risk factor emphasizes the importance of early detection, lifestyle intervention, and cardiovascular risk management in mitigating CSVD progression and outcomes.