Ethnic Disparities in Cerebral Small Vessel Disease Neuroimaging Markers and Risk Factors
Poster No:
1777
Submission Type:
Abstract Submission
Authors:
Nikita Husein1, Keshuo Lin1, David Chan1, Perminder Sachdev1, Wei Wen1
Institutions:
1University of New South Wales, Sydney, NSW
First Author:
Co-Author(s):
Introduction:
Cerebral small vessel disease (CSVD) is a common neurological condition affecting the brain's smallest blood vessels, theorised to drive age-related disease cases such as dementia and stroke (Elahi et al., 2023). Following the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria, key neuroimaging features include white matter hyperintensities of presumed vascular origin, microinfarcts, lacunes, cerebral microbleeds, and perivascular spaces (Duering et al., 2023). While CSVD prevalence is higher in low- and middle-income countries (Lam et al., 2023), ethnic variations in its manifestations remain poorly understood, particularly in community-dwelling populations where early detection could prevent severe outcomes. This systematic review and meta-analysis examined ethnic differences in MRI-based CSVD markers and cardiovascular, metabolic and lifestyle risk factors.
Methods:
Following PRISMA guidelines, this systematic review and meta-analysis analysed observational studies of community-dwelling adults from major databases through April 2024. Eligible studies utilised standardised MRI protocols (T1, T2, FLAIR, SWI, DTI/DWI) to evaluate CSVD markers and included proper ethnicity stratification across CSVD outcomes and risk factors. We excluded studies involving clinical populations (e.g., stroke or dementia patients) and those lacking proper reporting of main outcomes. Random-effects meta-regressions were performed with ethnicity and age as moderators. Heterogeneity was assessed using I² statistics and τ² estimates. The risk of bias was evaluated using RoBANS, focusing on selection bias, confounding factors, and outcome assessment.
Results:
We analysed 159 studies with over 2 million participants across White, Chinese, Korean, Japanese, and Black populations, identifying distinct ethnic patterns in CSVD markers and risk factors:
• East Asian Paradox: Japanese and Chinese populations demonstrated the highest CSVD markers despite favourable metabolic profiles. Japanese participants had the highest WMH volume (10.98 cm³) and lacune prevalence (16.8%) but lower BMI (23.4) and diabetes rates (11.0%). Chinese participants had high lacune (13.3%) and CMB prevalence (14.3%) despite moderate hypertension (24.6%) and low levels total cholesterol (186.5 mg/dL).
• Risk Factor Patterns: Black populations had the highest hypertension (54.7%), Latin populations the highest diabetes (22.6%), and White populations the highest BMI (26.5 kg/m²) and cholesterol (211.8 mg/dL).
• Age Trends: Significant associations included systolic BP (β=0.679, p<0.001), diabetes prevalence (β=0.035, p<0.001), microinfarcts (β=0.070, p=0.024), and decreasing smoking rates (β=-0.042, p<0.001).
• CSVD and Risk Factor Associations: Hypertension showed the strongest association with WMH volume in Japanese (β=11.83, p=0.015), followed by White (β=7.91, p=0.034) and Chinese populations (β=5.73, p=0.012). Age significantly predicted microinfarcts across all groups. Japanese populations showed unique associations between smoking and lacunes (β=1.13, p=0.020). Korean populations showed modest trends but lacked significant associations across CSVD markers.
• East Asian Paradox: Japanese and Chinese populations demonstrated the highest CSVD markers despite favourable metabolic profiles. Japanese participants had the highest WMH volume (10.98 cm³) and lacune prevalence (16.8%) but lower BMI (23.4) and diabetes rates (11.0%). Chinese participants had high lacune (13.3%) and CMB prevalence (14.3%) despite moderate hypertension (24.6%) and low levels total cholesterol (186.5 mg/dL).
• Risk Factor Patterns: Black populations had the highest hypertension (54.7%), Latin populations the highest diabetes (22.6%), and White populations the highest BMI (26.5 kg/m²) and cholesterol (211.8 mg/dL).
• Age Trends: Significant associations included systolic BP (β=0.679, p<0.001), diabetes prevalence (β=0.035, p<0.001), microinfarcts (β=0.070, p=0.024), and decreasing smoking rates (β=-0.042, p<0.001).
• CSVD and Risk Factor Associations: Hypertension showed the strongest association with WMH volume in Japanese (β=11.83, p=0.015), followed by White (β=7.91, p=0.034) and Chinese populations (β=5.73, p=0.012). Age significantly predicted microinfarcts across all groups. Japanese populations showed unique associations between smoking and lacunes (β=1.13, p=0.020). Korean populations showed modest trends but lacked significant associations across CSVD markers.
·Ethnicity ranked CSVD neuroimaging marker findings.
Conclusions:
This meta-analysis highlights significant ethnic disparities in CSVD burden and risk factors. Association findings reveal hypertension as a critical modifiable risk factor, particularly for East Asian and White populations, while age universally predicts microinfarcts. The associative findings relied on separate study-level data for CSVD markers and risk factors. This approach imposes limitations on establishing individual-level relationships between risk factors and CSVD outcomes. Future research should prioritize participant-level analyses stratified by ethnicity to better capture nuanced interactions among genetic, environmental, and sociodemographic factors. Such efforts are essential for refining culturally tailored strategies to reduce the global burden of CSVD and mitigate health disparities.
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) 2
Lifespan Development:
Aging
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural)
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Subcortical Structures
White Matter Anatomy, Fiber Pathways and Connectivity 1
Keywords:
Aging
Cerebral Blood Flow
Cerebrovascular Disease
Meta- Analysis
Statistical Methods
STRUCTURAL MRI
Sub-Cortical
White Matter
1|2Indicates the priority used for review
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Provide references using APA citation style.
Duering, M., Adams, H. H. H., Fazekas, F., Wardlaw, J. M., & Dichgans, M. (2023). Neuroimaging standards for research into small vessel disease. The Lancet Neurology, 22(5), 398–409. https://doi.org/10.1016/S1474-4422(23)00045-6
Lam, B. Y. K., Shi, L., & Mok, V. C. T. (2023). Global burden of cerebral small vessel disease: A systematic review. Stroke, 54(3), 851–859. https://doi.org/10.1161/STROKEAHA.122.038267