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J Am Heart Assoc. 2018 Nov 6;7(21):e010533. doi: 10.1161/JAHA.118.010533.

Cardiovascular Risk Factors and White Matter Hyperintensities: Difference in Susceptibility in South Asians Compared With Europeans.

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1 School of Biomedical Engineering and Imaging Sciences King's College London London United Kingdom.
2 Dementia Research Centre UCL Institute of Neurology London United Kingdom.
5 Department of Medical Physics and Biomedical Engineering University College London Malet Place Engineering Building London United Kingdom.
3 MRC Unit for Lifelong Health and Ageing at UCL Department of Population Science & Experimental Medicine UCL Institute of Cardiovascular Science London United Kingdom.
4 Centre for Medical Imaging UCL Division of Medicine London United Kingdom.
6 Department of Radiology and Nuclear Medicine Neuroscience Campus Amsterdam VU University Medical Center Amsterdam The Netherlands.
7 Lysholm Department of Neuroradiology The National Hospital for Neurology and Neurosurgery London United Kingdom.
8 Brain Repair and Rehabilitation UCL Institute of Neurology London United Kingdom.


Background Cardiovascular risk factors vary between ethnicities but little is known about their differential effects on white matter hyperintensities ( WMH ), an indicator of brain aging and burden of cerebrovascular disease. Methods and Results Brain magnetic resonance imaging scans from 213 people of South Asian and 256 of European ethnicity (total=469) were analyzed for global and regional WMH load. Associations with cardiovascular risk factors and a composite cardiovascular risk score (National Cholesterol Education Programme Adult Treatment Panel III) were compared by ethnicity, diabetes mellitus, smoking, and hypertension status. Distributional patterns of WMH were similar by ethnicity but the vulnerability to specific risk factors differed. Associations between WMH and age or National Cholesterol Education Programme Adult Treatment Panel III scores were stronger in South Asians compared with Europeans. For instance, a year of age led to an excess of 3.8% (confidence interval=[0.2, 7.6]; P=0.04) of WMH load in frontal regions in South Asians compared with Europeans. In the diabetic subgroup, South Asians had more WMH than Europeans (+63.3%, confidence interval=[14.1, 133.9]; P=0.007), particularly in the deeper regions (+102% confidence interval=[24, 329]; P=0.004). In the population as a whole, diabetes mellitus was not, or only weakly, related to an increase in WMH volume (12.4%, confidence interval=[-10.7, 41.3]; P=0.32), and diabetes mellitus duration was a positive predictor of frontal periventricular WMH load in Europeans but not in South Asians. In turn, diastolic blood pressure was positively associated with WMH volumes in South Asians but not in Europeans. Hypertension was not associated with WMH load ( P=0.9). Conclusions Distribution patterns of WMH are similar in South Asians and Europeans but older age and higher cardiovascular risk are associated with more WMH in South Asians.


aging; cerebral small vessel disease; ethnicity; magnetic resonance imaging; risk factor; white matter

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