The following is a summary of “Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis,” published in the November 2023 issue of Cardiology by Scheuermann et al.

Cerebral small vessel disease (cSVD) stands as a significant contributor to ischemic stroke and dementia, yet the precise vascular mechanisms underlying cSVD remain elusive. This systematic review and meta‐analysis aimed to elucidate the connections between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS).

The investigation encompassed a comprehensive search across MEDLINE, Web of Science, and Embase from inception to September 2023, targeting studies linking CVR, cerebral autoregulation, or AS to radiological markers of cSVD. 

Among 1,611 studies initially identified, 142 were included in the systematic review, with 60 providing data for subsequent meta‐analyses. The review confirmed consistent associations between cSVD and CVR, cerebral autoregulation, and AS in a significant majority of studies (80.4%, 78.6%, and 85.4%, respectively). A meta-analysis involving 7 studies (536 participants, 32.9% women) indicated a borderline relationship between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99–5.14]; P=0.05). Similarly, analysis of 37 studies (27 952 participants, 53.0% women) showcased a compelling link between elevated AS, per standard deviation, and cSVD (OR, 1.24 [95% CI, 1.15–1.33]; P<0.01). Further meta‐regression, adjusted for comorbidities, accounted for a substantial portion of the variance in the AS model (R2=29.4%, Pmoderators=0.02). Subgroup analysis from AS studies emphasized a robust association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18–1.70]; P<0.01).

The comprehensive review and meta-analyses underscore a tangible association between cSVD and compromised CVR alongside heightened AS. Nonetheless, longitudinal investigations into these vascular parameters as potential risk factors for cSVD are imperative for comprehensive understanding.

Source: ahajournals.org/doi/10.1161/JAHA.123.032616