Journal Club: Relationship between carotid arterial properties and cerebral white matter hyperintensities

White matter hyperintensities (WMH) are generally diagnosed on brain MRI and are associated with risk of stroke, dementia, death, and functional impairment.1,2 Their progression appears to be insidious, and the detection of preclinical disease could provide the opportunity to aggressively manage risk factors (i.e., reduced thresholds to begin hypertension treatment, lowering blood pressure targets), increase monitoring frequency, and begin secondary prevention strategies in the case of silent infarcts (i.e., initiation of antiplatelet therapy with silent strokes, CT angiography as needed). Given that most people do not receive neuroimaging in the presymptomatic stage, an inexpensive, noninvasive test could help to identify those at risk. To date, potential vascular markers of cerebrovascular disease have focused on central arterial stiffness3; however, directly assessing the carotid arteries may be more relevant to cerebrovascular disease as this vessel serves as the primary conduit responsible for delivering blood to the brain.