Association of cerebral white matter hyperintensities with coronary artery calcium in a healthy population: a cross-sectional study

Abstract

In brain magnetic resonance imaging (MRI), white matter hyperintensity (WMH) is a commonly encountered finding and is known to reflect cerebral small vessel disease. The aim of our study was to investigate the association of coronary artery calcium (CAC) with WMH and elucidate the relationship between WMH and atherosclerotic risk factors in a large-scale healthy population. This retrospective study included 1337 individuals who underwent brain MRI and CAC scoring computed tomography at healthcare centers affiliated with a tertiary hospital. Cerebral WMH was defined as Fazekas score greater than 2 on brain MRI. Intracranial artery stenosis (ICAS) was also assessed and determined to be present when stenosis was more than 50% on angiography. The associations of risk factors, CAC score, and ICAS with cerebral WMH were assessed by multivariable regression analysis. In multivariable analysis, categories of higher CAC scores showed increased associations with both periventricular and deep WMHs in a dose-dependent relationship. The presence of ICAS was also significantly related to cerebral WMH, and among the clinical variables, age and hypertension were independent risk factors. In conclusion, CAC showed a significant association with cerebral WMH in a healthy population, which might provide evidence for referring to the CAC score to identify individuals with risk of cerebral WMH.

Cerebral white matter hyperintensities indicate severity and progression of coronary artery calcification

“…Our results are of interest as previous studies led to speculations about the mechanisms behind the association of cerebral WMH—a hallmark feature of cerebral small vessel disease—and (subclinical) large vessel atherosclerosis such as CAC 8 – 11 . A combination of shared classical vascular risk factors (predominantly arterial hypertension) and a genetic predisposition was suspected behind this phenomenon 8 – 11 . In this context, Johansen et al identified differences in the strengths of the relationship between CAC and different WMH subtypes 9 .…”

“…As atherosclerotic large vessel disease results in the stiffening of arteries, it is hypothesized that the subsequent increase in blood-flow pulsatility within the brain-supplying vessels directly damages the small cerebral vasculature, thereby promoting WMH 9 , 12 , 13 . For this reason, CAC was assumed to predict cerebral WMH progression, but previous studies only had cross-sectional data available 8 – 11 .…”

“…Moreover, WMH have also been associated with subclinical atherosclerotic large vessel disease 8 , 9 . In particular coronary artery calcification (CAC), a well-known marker of coronary artery disease, has been related to WMH severity 8 – 11 .…”

“…Moreover, WMH have also been associated with subclinical atherosclerotic large vessel disease 8 , 9 . In particular coronary artery calcification (CAC), a well-known marker of coronary artery disease, has been related to WMH severity 8 – 11 . Apart from age, genetic predisposition, and classical vascular risk factors, previous studies suggested a more direct pathophysiological link between atherosclerotic large vessel disease and cerebral WMH 9 , 12 .…”

“…Consequently, coronary artery atherosclerosis has been postulated as a potential early indicator of WMH progression 9 . However, all studies published thus far are limited by their cross-sectional design 8 – 11 .…”