Aortic stiffness and cerebral microbleeds: The Framingham Heart Study

Cerebral small vessel disease (CSVD) is the most common subtype of cerebrovascular disease contributing to stroke and dementia.1,2 Cerebral microbleeds (CMB) represent hemorrhage-prone CSVD, generally attributed to hypertensive angiopathy, cerebral amyloid angiopathy, or both. CMB result from progressive structural and functional alterations of the blood vessel wall, evolving over a period of years to decades before clinical stroke and dementia are diagnosed, thus providing an opportunity for early intervention and prevention when identified. Further, CMB may increase bleeding complications from anticoagulant, thrombolytic, and antiplatelet therapy, and increase risk of complications of antiamyloid treatment in clinical trials for Alzheimer’s dementia. Arterial stiffness may provide a mechanistic link between systemic vascular disease and CSVD by transmission of abnormal flow pulsations from the central arteries into the small cerebral arteries,3 or interfering with toxic product clearance from the brain via perivascular spaces.4 In patients with stroke, arterial stiffness has been associated with CMB.5 We aimed to study the relation of carotid-femoral pulse wave velocity (CFPWV), as a measure of aortic stiffness, and CMB prevalence in community dwelling individuals. We further studied modification of this relation by genetic factors, vascular risk factors, and treatments to further generate hypotheses for potential treatment targets and preventive strategies.