Population-based Ethnoracial Disparity in Life's Essential 8 Vascular Health, Cerebral Small Vessel Disease & Cognition
- 1University of New South Wales
Abstract
BackgroundWhether ethnoracial differences in cerebral small vessel disease (cSVD) appear in multimarker burden, particular MRI manifestations, or both, and how they relate to Lifes Essential 8 (LE8) cardiovascular health and cognition, is unclear.
MethodsThis cross-sectional study included 44,982 participants and an age- and sex-matched subsample of 1,426 with reviewed lacune and cerebral microbleed (CMB) ratings. White, South Asian, Black, Chinese and Mixed participants were compared on 0-2 (white matter hyperintensity [WMH]/enlarged perivascular space [ePVS]) and 0-4 (adding CMB and lacunes) composite scores and each marker. LE8 was related to WMH and composite burden, and cognitive means were compared by group. Models were age-, sex- and center-adjusted with false-discovery-rate correction.
ResultsBoth composite scores differed across groups (0-2: P=0.00010; 0-4: P=0.0011), with greater burden in Black than South Asian (0-4: OR 1.66; 95% CI, 1.21-2.28) and Chinese participants (OR 2.36; 1.51-3.70), whereas Black-White contrasts were not detected. Black participants had higher WMH volume than White participants ({beta}=0.209; 0.110-0.308), robust to deprivation adjustment and segmentation method; South Asian participants had fewer ePVS (0.82; 0.72-0.93). No ethnoracial-group differences in lacune or CMB counts were detected after correction. Higher LE8 was associated with lower WMH volume ({beta}=-0.13 per SD; -0.17 to -0.09) and lower two-marker burden (OR 0.89 per SD; 0.87-0.91) without detected ethnoracial moderation. Black participants, who had the least favorable LE8 scores, and South Asian participants had lower global cognition than White participants (z -0.76 and -0.57 versus 0.24) despite differing WMH profiles; the pooled WMH-cognition association was null.
ConclusionsEthnoracial differences in multimarker cSVD burden were evident but marker-dependent: WMH showed the clearest Black-White difference; focal-lesion contrasts were inconclusive. Better cardiovascular health related to lower WMH and aggregate cSVD burden across groups, whereas cognitive differences did not track cSVD burden, supporting prospective prevention and cognition studies.
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BibTeX
@misc{husein2026populationbased,
title = {{Population-based Ethnoracial Disparity in Life's Essential 8 Vascular Health, Cerebral Small Vessel Disease & Cognition}},
author = {N. K. Husein and M. P. Ho and K. Lin and D. K. E. Chan and S. Hayashi and S. P. Sachdev and T. Hassanzadeh and J. Jiang and P. S. Sachdev and W. Wen},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.09.26365181},
url = {https://www.medrxiv.org/content/10.64898/2026.10.09.26365181v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Population-based Ethnoracial Disparity in Life's Essential 8 Vascular Health, Cerebral Small Vessel Disease & Cognition
AU - N. K. Husein
AU - M. P. Ho
AU - K. Lin
AU - D. K. E. Chan
AU - S. Hayashi
AU - S. P. Sachdev
AU - T. Hassanzadeh
AU - J. Jiang
AU - P. S. Sachdev
AU - W. Wen
PY - 2026
DA - 2026/10/09
PB - medRxiv
DO - 10.64898/2026.10.09.26365181
UR - https://www.medrxiv.org/content/10.64898/2026.10.09.26365181v1
AB - BackgroundWhether ethnoracial differences in cerebral small vessel disease (cSVD) appear in multimarker burden, particular MRI manifestations, or both, and how they relate to Lifes Essential 8 (LE8) cardiovascular health and cognition, is unclear. MethodsThis cross-sectional study included 44,982 participants and an age- and sex-matched subsample of 1,426 with reviewed lacune and cerebral microbleed (CMB) ratings. White, South Asian, Black, Chinese and Mixed participants were compared on 0-2 (white matter hyperintensity [WMH]/enlarged perivascular space [ePVS]) and 0-4 (adding CMB and lacunes) composite scores and each marker. LE8 was related to WMH and composite burden, and cognitive means were compared by group. Models were age-, sex- and center-adjusted with false-discovery-rate correction. ResultsBoth composite scores differed across groups (0-2: P=0.00010; 0-4: P=0.0011), with greater burden in Black than South Asian (0-4: OR 1.66; 95% CI, 1.21-2.28) and Chinese participants (OR 2.36; 1.51-3.70), whereas Black-White contrasts were not detected. Black participants had higher WMH volume than White participants ({beta}=0.209; 0.110-0.308), robust to deprivation adjustment and segmentation method; South Asian participants had fewer ePVS (0.82; 0.72-0.93). No ethnoracial-group differences in lacune or CMB counts were detected after correction. Higher LE8 was associated with lower WMH volume ({beta}=-0.13 per SD; -0.17 to -0.09) and lower two-marker burden (OR 0.89 per SD; 0.87-0.91) without detected ethnoracial moderation. Black participants, who had the least favorable LE8 scores, and South Asian participants had lower global cognition than White participants (z -0.76 and -0.57 versus 0.24) despite differing WMH profiles; the pooled WMH-cognition association was null. ConclusionsEthnoracial differences in multimarker cSVD burden were evident but marker-dependent: WMH showed the clearest Black-White difference; focal-lesion contrasts were inconclusive. Better cardiovascular health related to lower WMH and aggregate cSVD burden across groups, whereas cognitive differences did not track cSVD burden, supporting prospective prevention and cognition studies.
ER -