Risk factors for small vessel disease in adults with atherosclerosis: a systematic review and meta-analysis.

INTRODUCTION: Atherosclerosis is marked by irregular intimal plaques, known as atheroma, which intrude into the lumen of medium-sized and large arteries. Small vessel disease (SVD) is a major contributor to stroke and cognitive impairment and frequently coexists with atherosclerosis due to shared vascular risk factors and overlapping pathophysiological mechanisms. This meta-analysis aimed to systematically evaluate the association between atherosclerotic risk factors and the development of SVD in adult and elderly populations. METHOD: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, ScienceDirect, Elsevier, and Google Scholar were searched for eligible studies published between January 2000 and October 2023. Community-based randomized controlled trials and observational studies assessing atherosclerotic risk factors and SVD-related outcomes, primarily carotid intima-media thickness and carotid plaque, were included. Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using funnel plots and sensitivity analyses. RESULTS: Across 11 studies with sample sizes ranging from 50 to 5,585 participants, age and hypertension consistently demonstrated the strongest associations with SVD. Age showed an odds ratio of 1.07 (95% CI: 1.03–1.11; p = 0.0001), while hypertension yielded a pooled odds ratio of 2.24 (95% CI: 1.90–2.64; p < 0.0001). Diabetes was also significant (OR 1.38; p < 0.0001), whereas metabolic syndrome was not (p = 0.69). CONCLUSION: The study concludes that hypertension, age, diabetes mellitus, and carotid atherosclerotic markers—particularly carotid plaque—are significant predictors of SVD.