Accelerated vascular aging: Ethnic differences in basilar artery length and diameter, and its association with cardiovascular risk factors and cerebral small vessel disease

Carole H Sudre; Stefano Moriconi; Rafael Rehwald; Lorna Smith; Therese Tillin; Josephine Barnes; David Atkinson; Sébastien Ourselin; Nish Chaturvedi; Alun D Hughes; H Rolf Jäger; M Jorge Cardoso

doi:10.3389/fcvm.2022.939680

Accelerated vascular aging: Ethnic differences in basilar artery length and diameter, and its association with cardiovascular risk factors and cerebral small vessel disease

Front Cardiovasc Med. 2022 Jul 28:9:939680. doi: 10.3389/fcvm.2022.939680. eCollection 2022.

Authors

Carole H Sudre^{1

2

3}, Stefano Moriconi³, Rafael Rehwald^{4

5}, Lorna Smith⁶, Therese Tillin¹, Josephine Barnes⁷, David Atkinson⁶, Sébastien Ourselin³, Nish Chaturvedi¹, Alun D Hughes¹, H Rolf Jäger⁵, M Jorge Cardoso³

Affiliations

¹ MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.
² Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom.
³ School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
⁴ Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
⁵ Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, University College London, London, United Kingdom.
⁶ Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom.
⁷ Dementia Research Centre, UCL Institute of Neurology, University College London, London, United Kingdom.

Abstract

Background and aims: Risk of stroke and dementia is markedly higher in people of South Asian and African Caribbean descent than white Europeans in the UK. This is unexplained by cardiovascular risk factors (CVRF). We hypothesized this might indicate accelerated early vascular aging (EVA) and that EVA might account for stronger associations between cerebral large artery characteristics and markers of small vessel disease.

Methods: 360 participants in a tri-ethnic population-based study (120 per ethnic group) underwent cerebral and vertebral MRI. Length and median diameter of the basilar artery (BA) were derived from Time of Flight images, while white matter hyperintensities (WMH) volumes were obtained from T1 and FLAIR images. Associations between BA characteristics and CVRF were assessed using multivariable linear regression. Partial correlation coefficients between WMH load and BA characteristics were calculated after adjustment for CVRF and other potential confounders.

Results: BA diameter was strongly associated with age in South Asians (+11.3 μm/year 95% CI = [3.05; 19.62]; p = 0.008), with unconvincing relationships in African Caribbeans (3.4 μm/year [-5.26, 12.12]; p = 0.436) or Europeans (2.6 μm/year [-5.75, 10.87]; p = 0.543). BA length was associated with age in South Asians (+0.34 mm/year [0.02; 0.65]; p = 0.037) and African Caribbeans (+0.39 mm/year [0.12; 0.65]; p = 0.005) but not Europeans (+0.08 mm/year [-0.26; 0.41]; p = 0.653). BA diameter (rho = 0.210; p = 0.022) and length (rho = 0.261; p = 0.004) were associated with frontal WMH load in South Asians (persisting after multivariable adjustment for CVRF).

Conclusions: Compared with Europeans, the basilar artery undergoes more accelerated EVA in South Asians and in African Caribbeans, albeit to a lesser extent. Such EVA may contribute to the higher burden of CSVD observed in South Asians and excess risk of stroke, vascular cognitive impairment and dementia observed in these ethnic groups.

Keywords: aging; basilar artery (BA); cerebral small vessel disease; early vascular aging; ethnicity; white matter hyperintensities (WMH).

Abstract

Grants and funding