Simple Interventions: A Clue to Tackle Cerebral Small Vessel Disease.

Abstract

HomeStrokeVol. 53, No. 9Simple Interventions: A Clue to Tackle Cerebral Small Vessel Disease Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBSimple Interventions: A Clue to Tackle Cerebral Small Vessel Disease José Rafael Romero, MD José Rafael RomeroJosé Rafael Romero Correspondence to: José Rafael Romero, MD, Department of Neurology, Boston University School of Medicine, 715 Albany St, B-608, Boston, MA 02118. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1101-2950 Department of Neurology, Boston University School of Medicine, MA. Search for more papers by this author Originally published17 Aug 2022https://doi.org/10.1161/STROKEAHA.122.039953Stroke. 2022;53:2868–2869This article is a commentary on the followingAssociations of Life’s Simple 7 With Cerebral Small Vessel DiseaseOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 17, 2022: Ahead of Print See related article, p 2859Cerebral small vessel disease (CSVD) is increasingly recognized as a cause of several clinically important neurological syndromes. CSVD has long been defined as a mechanism of stroke, accounting for approximately 25% of ischemic strokes and most intracerebral hemorrhages and contributing to approximately 50% of dementias.1,2 However, clinical events are the tip of the iceberg, only reflecting a small fraction of the true burden of CSVD. The most common forms of CSVD are the sporadic types, including hypertensive arteriopathy and cerebral amyloid angiopathy. Autopsy studies suggest a prevalence of these arteriopathies of around 10% to 30% of elderly persons and 35% to 90% of all persons with dementia.3 In population-based studies assessing CSVD markers on brain magnetic resonance imaging, the prevalence of CSVD is estimated to be 8% to 30%, depending on the marker, the threshold for severity, and the age of the cohort.4,5 In clinical samples, a much higher prevalence of up to 80% has been reported.5 Thus, CSVD has enormous implications for public health in the United States and around the world.The study by Liu et al6 reports on the relation of Life’s Simple 7 and CSVD in 3067 participants from the PRECISE study (Polyvascular Evaluation for Cognitive Impairment and Vascular Events)—a population-based prospective cohort study in community-dwelling older adults in China. Life’s Simple 7 includes behavioral and medical metrics. The behavioral metrics were smoking, weight—body mass index, physical activity, and diet; the medical metrics were blood pressure, blood glucose, and total cholesterol. Life’s Simple 7 was modeled as a composite score (range, 0–7) and subscores based on the medical and behavioral metrics separately, both stratified into poor, intermediate, and ideal. Brain magnetic resonance imaging measures of CSVD were rated using standard criteria and sequences and included white matter hyperintensities, lacunes, cerebral microbleeds, and perivascular spaces. Two total CSVD scores were evaluated as outcomes (total and modified total CSVD scores). The modified score provided additional strata for markers with different burden (perivascular spaces, cerebral microbleeds, and white matter hyperintensities). The main findings of this study were inverse relations between Life’s Simple 7 scores and total CSVD burden, with an inverse dose-effect relation: lower CSVD burden with better ideal health score. The study further highlighted that it was the ideal Life’s Simple 7 group that was associated with lower total CSVD burden.Although no specific treatment is available for CSVD at present, targeting modifiable vascular risk factors is key to reduce stroke risk and heart disease7 and has been suggested to account for recent decrease in dementia incidence.8 In view of the critical role of CSVD in stroke and dementia, and modifiable nature of Life’s Simple 7 factors, the results of this study generate the hypothesis that to decrease the burden of CSVD, clinical care should aim to attain ideal and not just intermediate Life’s Simple 7. Further, this study adds to existent literature highlighting the value of considering assessment of CSVD burden even in asymptomatic individuals. However, results of this study are not based on a randomized clinical trial and call for further prospective studies evaluating Life’s Simple 7 as a treatment target for prevention of CSVD and its related consequences. Such studies should consider global burden of CSVD and follow-up long enough to detect meaningful effects of closely supervised Life’s Simple 7 interventions versus standard care, particularly in cognitive outcomes.In the meantime, it should be noted that the American Heart Association offers freely available educational online resources—My check | Life’s Simple 7,9—to increase the understanding of risk of heart disease and stroke at the individual level and promotion of health. Based on current prevention guidelines, clinicians should work together with patients to attain the ideal Life’s Simple 7.Article InformationDisclosures None.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Disclosures, see page 2869.Correspondence to: José Rafael Romero, MD, Department of Neurology, Boston University School of Medicine, 715 Albany St, B-608, Boston, MA 02118. Email [email protected]edu