Estimated Pulse‐Wave Velocity and Magnetic Resonance Imaging Markers of Cerebral Small‐Vessel Disease in the NOMAS

Background Pulse‐wave velocity is a measure of arterial stiffness and a risk factor for cardiovascular disease. Recently, an estimated pulse‐wave velocity (ePWV) was introduced that was predictive of increased risk of cardiovascular disease. Our objective was to determine whether ePWV was associated with cerebral small‐vessel disease on magnetic resonance imaging. Methods and Results We included 1257 participants from the NOMAS (Northern Manhattan Study). The ePWV values were calculated using a nonlinear function of age and mean arterial blood pressure. The association between ePWV and white matter hyperintensity volume was assessed. Modification by race and ethnicity was evaluated. Associations between ePWV and other cerebral small‐vessel disease markers, covert brain infarcts, cerebral microbleeds, and enlarged perivascular spaces, were explored as secondary outcomes. Mean±SD age of the cohort was 64±8 years; 61% were women; 18% self‐identified as non‐Hispanic Black, 67% as Hispanic, and 15% as non‐Hispanic White individuals. Mean±SD ePWV was 11±2 m/s in the total NOMAS population and was similar across race and ethnic groups. The ePWV was significantly associated with white matter hyperintensity volume (β=0.23 [95% CI, 0.20–0.26]) after adjustment. Race and ethnicity modified the association between ePWV and white matter hyperintensity volume, with stronger associations in Hispanic and non‐Hispanic Black individuals. Significant associations were found between ePWV and covert brain infarcts, cerebral microbleeds, and perivascular spaces after adjustment. Conclusions The ePWV function may provide a vascular mechanism for deleterious cerebrovascular outcomes in individuals with cerebral small‐vessel disease and is particularly apparent in the racial and ethnic minorities represented in the NOMAS cohort.