Cardiovascular risk and preclinical atherosclerosis are associated with white matter hyperintensities in apparently healthy adults: the population-based cross-sectional BIALYSTOK PLUS study.

INTRODUCTION

White matter hyperintensities, present in patients and asymptomatic individuals, have been previously shown to be associated with atherosclerosis risk factors, such as high blood pressure, hypercholesterolemia, smoking, and diabetes.

OBJECTIVES

Our aim was to examine the associations between the volume of white matter hyperintensities and cardiovascular risk factors in the general, apparently healthy population.

PATIENTS AND

METHODS

The analysis includes 735 participants (aged 20 to 79 years) without neurological or severe cardiac diseases. The participants underwent detailed clinical examination, including medical history, biochemical analyses, carotid arteries ultrasound, and brain magnetic resonance imaging, followed by white matter hyperintensities segmentation using the FreeSurfer tool. The participants were divided into 3 cardiovascular risk (CVR) categories based on the 2021 European Society of Cardiology guidelines.

RESULTS

The median volume of white matter hyperintensities was 95.2 mm3 (interquartile range, 2.1-482 mm3). Multivariable analysis revealed positive independent association between the volume of white matter hyperintensities and CVR categories, glycated hemoglobin concentration, presence of carotid plaques, and central systolic blood pressure. An analysis including individuals without hypertension or diabetes revealed mean intima‑media thickness and high or very high cardiovascular risk class as independent predictors of white matter hyperintensities percentile.

CONCLUSION

The cardiovascular risk class, presence of carotid plaques, increased intima‑media complex thickness, and diabetes are the main risk factors for white matter hyperintensities in apparently healthy adults. People without hypertension or diabetes but with higher CVR are also at a risk for developing white matter hyperintensities, which emphasizes the importance of CVR assessment for prediction of neurodegenerative changes.