Cardiovascular risk factors and white matter hyperintensities: Difference in susceptibility in South Asians compared to Europeans

Carole H. Sudre, Lorna Smith, David Atkinson, Nish Chaturvedi, Sebastien Ourselin, Frederik Barkhof, Alun D Hughes, M. Jorge Cardoso, Rolf H Jäger

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Abstract

Background: Cardiovascular (CV) risk factors vary between ethnicities but little is known about their differential effects on white matter hyperintensities (WMH), an indicator of brain ageing and burden of cerebrovascular disease.
Methods and Results Brain MRI scans from 213 people of South Asian and 256 of European ethnicity (total =469) were analysed for global and regional WMH load. Associations with CV risk factors and a composite CV risk score (NCEP-ATP-III) were compared by ethnicity, diabetes, 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 NCEP-ATP-III scores were stronger in South Asians compared to Europeans. A year of age led for instance to an excess of 3.8% (CI=[0.2 7.6];p=0.04) of WMH load in frontal regions in South Asians compared to Europeans. In the diabetic subgroup, South Asians had more WMH than Europeans (+63.3%, CI=[14.1;133.9];p=0.007), particularly in the deeper regions (+102% CI=[24; 329];p=0.004). In the population as a whole, diabetes was not, or only weakly, related to an increase in WMH volume (12.4%, CI=[-10.7 41.3];p=0.32), and diabetes 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 CV risk are associated with more WMH in South Asians.
Original languageEnglish
Article numbere010533
JournalJournal of the American Heart Association
Volume7
Issue number21
Early online date31 Oct 2018
Publication statusPublished - 6 Nov 2018

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