title: Arterial stiffness and cerebral small vessel disease: the Rotterdam Scan Study.
abstract: OBJECTIVE
  Aging and vascular risk factors contribute to arterial stiffening. Increased arterial stiffness exposes the small vessels in the brain to abnormal flow pulsations and, as such, may contribute to the pathogenesis of cerebral small vessel disease. In a population-based study, we investigated the association between arterial stiffness, as measured by aortic pulse wave velocity (aPWV), and small vessel disease.
  
  
  METHODS
  Overall, 1460 participants (mean age, 58.2 years) underwent aPWV measurement and brain MRI scanning. We calculated aPWV by measuring time differences and distances between pulse waves in the carotid and femoral arteries. Using automated MRI analysis, we obtained white matter lesion volumes. Infarcts and microbleeds were rated visually. We used linear and logistic regression models to associate aPWV with small vessel disease, adjusting for age, sex, mean arterial pressure, and heart rate and additionally for cardiovascular risk factors. Subsequently, we explored associations in strata of hypertension.
  
  
  RESULTS
  In the study group, higher aPWV was associated with larger white matter lesion volume (difference in volume per SD increase in aPWV 0.07; 95% CI, 0.02-0.12) but not with lacunar infarcts or microbleeds. In persons with uncontrolled hypertension, higher aPWV was significantly associated with larger white matter lesion volume (difference in volume per SD increase in aPWV 0.09; 95% CI, 0.00-0.18), deep or infratentorial microbleeds (OR, 2.13; 95% CI, 1.16-3.91), and to a lesser extent also with lacunar infarcts (OR, 1.63; 95% CI, 0.98-2.70). No such associations were present in persons with controlled hypertension or without hypertension.
  
  
  CONCLUSIONS
  In our study, increased arterial stiffness is associated with a larger volume of white matter lesions.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Mariëlle M F
authors.initials: MM
authors.lastname: Poels
authors.forename: Kèren
authors.initials: K
authors.lastname: Zaccai
authors.forename: Germaine C
authors.initials: GC
authors.lastname: Verwoert
authors.forename: Meike W
authors.initials: MW
authors.lastname: Vernooij
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.forename: Jacqueline C M
authors.initials: JC
authors.lastname: Witteman
authors.forename: Monique M B
authors.initials: MM
authors.lastname: Breteler
authors.forename: Francesco U S
authors.initials: FU
authors.lastname: Mattace-Raso
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D059345:Cerebral Small Vessel Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D063177:Pulse Wave Analysis; D012039:Regional Blood Flow / Q000502:physiology*; D059289:Vascular Stiffness / Q000502:physiology*