Abstract Number: Esoc2026a1339 Cerebral Small Vessel Disease Burden in Saudi Arabia: Epidemiology, Risk Determinants, and Neuroimaging Characteristics

Abstract Background and aims Cerebral small vessel disease (CSVD) is a major contributor to stroke, cognitive impairment, and gait disturbance. Data on its burden and determinants in Middle Eastern populations are limited. This study aimed to estimate the prevalence, clinical predictors, and neuroimaging correlates of CSVD in adults from Saudi Arabia, and to explore the influence of vascular risk factors and antihypertensive therapy. Methods We conducted a retrospective cross-sectional study of adults aged 40–70 years who underwent brain MRI at King Abdulaziz Medical City, Riyadh, between January 2018 and January 2019. CSVD markers were identified using the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria, with white matter hyperintensities (WMH) graded by the Fazekas scale. Multivariable logistic regression was used to identify factors associated with CSVD. Results Among 644 participants, CSVD was identified in 36.5%. Prevalence increased with age, from 18.2% in those aged 40–50 years to 54.1% in those aged 60–70 years (p 0.001). Diabetes mellitus showed the strongest association with CSVD (odds ratio OR = 6.4; p 0.001), followed by hypertension and dyslipidemia. Use of calcium channel blockers was associated with a lower prevalence of CSVD. WMH were the most frequent neuroimaging finding, with greater severity observed in older age groups (p 0.001). Conclusions CSVD represents a substantial disease burden in this Saudi cohort, driven largely by modifiable vascular risk factors. The observed association between antihypertensive medication class and CSVD prevalence suggests that blood pressure management strategies may differentially influence small-vessel pathology, warranting further investigation Conflict of interest Nothing to disclose