Brain Perivascular Spaces as Biomarkers of Vascular Risk: Results from the Northern Manhattan Study

Abstract

Background Dilated perivascular spaces (PVS) in the brain are associated with greater arterial pulsatility. We hypothesized that PVS identify individuals at higher risk of systemic and cerebral vascular events. Methods Stroke-free participants in the population-based Northern Manhattan Study had brain MRI performed, and were followed for myocardial infarction, any stroke, and death. Imaging analyses distinguished PVS from lesions presumably ischemic (LPI). PVS were further subdivided into lesions with diameter of ≤ 3 mm (small PVS) and > 3 mm (large PVS). We calculated relative rates of events with Poisson models, and hazard ratios (HR) with Cox proportional models. Results NOMAS participants who had MRI data available for review (n=1228; 59% women, 65% Hispanic, mean age 71 ± 9 years) were followed for an average of 9 ± 2 years. Participants in the highest tertile of the small PVS score had higher relative rate of all death (1.38, 1.01–1.91), vascular death (1.87, 1.12–3.14), myocardial infarction (2.08, 1.01–4.31), any stroke (1.79, 1.03–3.11), and any vascular event (1.74, 1.18–2.56). After adjusting for confounders there was a higher risk of vascular death (HR 1.06, 1.01–1.11), myocardial infarction (HR 2.22, 1.12–4.42), and any vascular events (HR 1.04, 1.01–1.08) with a higher small PVS scores. Conclusions In this multi-ethnic, population-based study, participants with a high burden of SPVS had increased risk of vascular events. By gaining pathophysiological insight into the mechanism of PVS dilatation, we may be able to propose novel therapies to better prevent vascular disorders in the population.

Enlarged perivascular spaces are associated with health‐related quality of life in patients with acute ischemic stroke

“…2 In a population-based study of older adults, stroke-free subjects with higher burden of EPVS had higher rate of carotid atherosclerosis 27 as well as higher risk of mortality, incidence of any stroke or any other vascular events in a 10-year follow-up. 28 EPVS in the basal ganglia had larger impact on poststroke HRQoL than in the centrum semiovale which were found in this study. They also had different effects on the subscores of the SSQoL.…”

“…Further, stroke patients with higher degree of EPVS in the basal ganglia had a higher risk of recurrent stroke . One possible explanation for these findings was that more EPVS meant more severe underlying microvascular lesions and aggregation of vascular risk factors, which, in turn, increased the incidence of vascular events . Vascular risk factors and vascular events could explain the poor HRQoL in stroke .…”

“…Vascular risk factors and vascular events could explain the poor HRQoL in stroke . In a population‐based study of older adults, stroke‐free subjects with higher burden of EPVS had higher rate of carotid atherosclerosis as well as higher risk of mortality, incidence of any stroke or any other vascular events in a 10‐year follow‐up …”

“…16 One possible explanation for these findings was that more EPVS meant more severe underlying microvascular lesions 26 and aggregation of vascular risk factors, which, in turn, increased the incidence of vascular events. 27,28 Vascular risk factors and vascular events could explain the poor HRQoL in stroke. 2 In a population-based study of older adults, stroke-free subjects with higher burden of EPVS had higher rate of carotid atherosclerosis 27 as well as higher risk of mortality, incidence of any stroke or any other vascular events in a 10-year follow-up.…”

Association Between Steno-Occlusive Middle Cerebral Artery and Basal Ganglia Perivascular Spaces

“…Impaired arterial stiffness (13) and increased pulsatility index (14) were found in severe MCA stenosis. Moreover, previous studies showed increased cerebrovascular pulsatility and arterial stiffness were related to increased BG-EPVS (15)(16)(17). Based on these findings, it is reasonable to imagine that BG-EPVS might be more prevalent in patients with severe MCA atherosclerosis.…”