Research Paper|Volume 13, Issue 18|pp 22030—22039

Cerebral small vessel disease, systemic vascular characteristics and potential therapeutic targets

Salim Elyas^1,², Damilola Adingupu¹, Kunihiko Aizawa¹, Francesco Casanova¹, Kim Gooding¹, Jonathan Fulford¹, Dave Mawson¹, Phillip E. Gates¹, Angela C. Shore¹, David Strain^1,²

¹Institute of Biomedical and Clinical Science and NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter EX2 5AX, UK
²Academic Department of Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK

Received: April 6, 2021Accepted: August 31, 2021Published: September 22, 2021

https://doi.org/10.18632/aging.203557

Copyright: © 2021 Elyas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

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.