Materiały źródłowe

• #1 Prevention and Management of Cerebral Small Vessel Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4460330/

  Lacunar infarcts/lacunes, white matter hyperintensities (WMH), and cerebral microbleeds (CMBs) are considered various manifestations of cerebral small vessel disease (SVD). […] High blood pressure is the most consistent risk factor for all of these manifestations. […] According to the Secondary Prevention of Small Subcortical Strokes trial results, a blood pressure reduction to 130 mmHg is recommended in patients with symptomatic lacunar infarction. […] Dual antiplatelet therapy (aspirin plus clopidogrel) should be avoided because of the excessive risk of intracerebral hemorrhage. […] Although no particular antiplatelet is recommended, drugs such as cilostazol or triflusal may have advantages for patients with SVD since they are associated with less frequent bleeding complications than aspirin.

• #2 Prevention and Management of Cerebral Small Vessel Disease

  https://www.j-stroke.org/journal/view.php?number=73&viewtype=pubreader

  Lacunar infarcts/lacunes, white matter hyperintensities (WMH), and cerebral microbleeds (CMBs) are considered various manifestations of cerebral small vessel disease (SVD). […] High blood pressure is the most consistent risk factor for all of these manifestations. […] According to the Secondary Prevention of Small Subcortical Strokes trial results, a blood pressure reduction to 130 mmHg is recommended in patients with symptomatic lacunar infarction. […] Dual antiplatelet therapy (aspirin plus clopidogrel) should be avoided because of the excessive risk of intracerebral hemorrhage. […] Although no particular antiplatelet is recommended, drugs such as cilostazol or triflusal may have advantages for patients with SVD since they are associated with less frequent bleeding complications than aspirin.

• #3 Prevention and Management of Cerebral Small Vessel Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4460330/

  The benefits of lowering BP are apparent in secondary stroke prevention. […] Therefore, it is appropriate to reduce the systolic BP to 130 mmHg in patients with lacunar infarction. […] However, the long-term effect of BP reductions remains uncertain, especially in old patients with extensive SVD. […] Therefore, although a systolic BP reduction to 130 mmHg is currently recommended in the guidelines, and BP management may have be more cautiously made in patients with advanced age, a long history of hypertension, extensive WMH, or cognitive dysfunction. […] In the recent VITATOPS MRI-substudy, homocysteine lowering using B-vitamins was associated with a reduced WMH volume increment in those with severe baseline SVD (i.e., confluent WMH and lacunes). […] In addition, vitamin E tocotrienols were recently found to attenuate the progression of WMH among healthy subjects with WMH. […] Therefore, cilostazol seems to be safer than aspirin in terms of the risk of hemorrhagic stroke in hypertensive patients with SVD. […] Further studies are required to find the appropriate antiplatelets in patients with SVD.

• #4 Small vessel disease // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/small-vessel-disease

  Control blood pressure. Ask your health care provider how frequently you should have your blood pressure measured. He or she might recommend more-frequent checks if you have high blood pressure or a history of heart disease. […] Control blood sugar. Work with your health care provider to establish blood sugar goals that are right for you. […] Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, listening to music and connecting with others in support groups are some ways to reduce stress.

• #5 Mayo Clinic Health Library – Small vessel disease | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20166493

  Control blood pressure. Ask your health care provider how frequently you should have your blood pressure measured. He or she might recommend more-frequent checks if you have high blood pressure or a history of heart disease. […] Control blood sugar. Work with your health care provider to establish blood sugar goals that are right for you. […] Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, listening to music and connecting with others in support groups are some ways to reduce stress. […] Heart-healthy lifestyle changes can help prevent and manage small vessel disease. Lifestyle changes may include: […] Losing weight if you’re not at a healthy weight […] Getting regular physical activity […] Eating a healthy diet that’s low in salt and rich in fruit, vegetables, lean protein and whole grains […] Quitting smoking or tobacco use.

• #6 Small vessel disease // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/small-vessel-disease

  Things you can do that might reduce your risk of small vessel disease include: […] Don’t smoke or use other tobacco products. If you smoke or use tobacco, stop. Talk to your health care provider if you have trouble quitting. […] Eat a heart-healthy diet. Choose a diet rich in whole grains, lean meat, low-fat dairy, and fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats. […] Exercise regularly. Regular exercise helps improve heart muscle function and keeps blood flowing through the arteries. Aim for at least 150 minutes a week of moderate activity such as walking. […] Maintain a healthy weight. Excess weight strains the heart and can contribute to high cholesterol, high blood pressure and diabetes. […] Manage cholesterol. Ask your health care provider how often you should have your cholesterol numbers checked. If your bad cholesterol (low-density lipoprotein cholesterol) levels are high, your health care provider may prescribe changes to your diet and medications to help lower your cholesterol levels and protect your cardiovascular health.

• #7 Mayo Clinic Health Library – Small vessel disease | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20166493

  Things you can do that might reduce your risk of small vessel disease include: […] Don’t smoke or use other tobacco products. If you smoke or use tobacco, stop. Talk to your health care provider if you have trouble quitting. […] Eat a heart-healthy diet. Choose a diet rich in whole grains, lean meat, low-fat dairy, and fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats. […] Exercise regularly. Regular exercise helps improve heart muscle function and keeps blood flowing through the arteries. Aim for at least 150 minutes a week of moderate activity such as walking. […] Maintain a healthy weight. Excess weight strains the heart and can contribute to high cholesterol, high blood pressure and diabetes. […] Manage cholesterol. Ask your health care provider how often you should have your cholesterol numbers checked. If your bad cholesterol (low-density lipoprotein cholesterol) levels are high, your health care provider may prescribe changes to your diet and medications to help lower your cholesterol levels and protect your cardiovascular health.

• #8 Small Vessel Disease – Angina – Symptoms | familydoctor.org

  https://familydoctor.org/condition/small-vessel-disease/

  The best way to prevent small vessel disease is by reducing your risk factors. […] Lose weight. If you are overweight, create a weight loss plan with your doctor. […] Don’t smoke. Nicotine raises your blood pressure by causing your body to release adrenaline. It constricts your blood vessels and makes your heart beat faster. If you smoke, ask your doctor for help to quit. […] Control your blood pressure. If you have high blood pressure, your doctor can suggest ways to lower it. Take medicines to treat high blood pressure should be taken with caution, per your doctor’s orders. […] Improve your cholesterol levels. A healthy diet and exercise can balance your cholesterol levels. They lower your “bad” cholesterol (LDL) and raise your “good” cholesterol (HDL). LDL blocks your blood vessels and increases your risk of developing heart disease. Medicine also can help with this.

• #9 CUHK Screening Reveals 1 in 3 Older Adults in Community Suffer Brain Small Vessel Disease, Early Prevention Recommended – Press Releases – News – Faculty of Medicine, The Chinese University of Hong Kong.

  https://www.med.cuhk.edu.hk/press-releases/cuhk-screening-reveals-1-in-3-older-adults-in-community-suffer-brain-small-vessel-disease-early-prevention-recommended

  CUHK encourages Hong Kong citizens to control vascular risk factors to prevent dementia and stroke. […] The public should also proactively prevent stroke and dementia associated with brain SVD by enhancing vascular and cognitive health with integrated healthy lifestyle including the following: Monitor and control blood pressure, blood sugar and lipid levels, Stop smoking, Maintain a healthy weight, Reduce excessive alcohol consumption, Do physical exercises and mental activities like reading, using computer or playing games (such as board games) regularly, Maintain an active social life (e.g. joining elderly centres or interest classes and participating in volunteer work, etc.). […] More research is thus needed to explore treatments for SVD. Currently the research team is exploring a newer anti-platelet agent for the treatment of SVD in people without dementia or stroke.

• #10 Small vessel disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123

  The goals of treatment for small vessel disease are to control the narrowing of the small blood vessels that can lead to a heart attack and to relieve pain. […] Heart-healthy lifestyle changes can help prevent and manage small vessel disease. Lifestyle changes may include: Losing weight if you’re not at a healthy weight, Getting regular physical activity, Eating a healthy diet that’s low in salt and rich in fruit, vegetables, lean protein and whole grains, Quitting smoking or tobacco use. […] Sometimes, the dietary supplement L-arginine may benefit people with small vessel disease who haven’t been helped by other medications. L-arginine is an amino acid that helps relax blood vessels.

• #11 Stroke: New research into small blood vessels may help reduce risk

  https://www.medicalnewstoday.com/articles/how-research-into-small-blood-vessels-may-help-prevent-stroke-vascular-dementia

  Researchers are looking into the potential causes of cerebral small vessel disease by growing small blood vessel models in a lab. […] They said they hope to discover potential treatments for the condition, which can occur in people who have diseases such as high blood pressure and type 2 diabetes. […] Regular exercise, healthy diet, Mediterranean diet, folic acid, and vitamin B12 and avoiding adverse lifestyle factors such as smoking, excess alcohol or high dietary sodium, are all associated with having fewer SVD features in observational studies. […] Treatment often involves treating the underlying cause, such as practicing preventative strategies or treating an ischemic stroke. […] Secondary prevention measures typically include antithrombotics, glycemic control, antihypertensives, and statins, as well as promoting wellness, social connectedness, a Mediterranean diet, and regular exercise. […] Our current strategies are supported by evidence implying their effectiveness in mitigating some of the effects and progression of vascular disease, but there is undoubtedly a need for precision-based medical strategies that target these mechanistic pathways with more efficacy.

• #12 Cerebral Small Vessel Disease | Symptoms, Diagnosis, Advice and More | 2024 – Pure Medical

  https://pure-medical.co.uk/cerebral-small-vessel-disease-2

  Follow these tips to protect your brain from Cerebral small vessel disease: […] Work with your doctor and a dietician to get your weight back into a healthy range if you’re overweight. […] Follow a nutritious diet, such as the Mediterranean or DASH diets, which are low in saturated fat, sugar, and sodium. […] If you smoke, choose a stop smoking approach that works for you. Counselling, nicotine replacement treatments, or drugs that diminish your desire to smoke are all options. […] Your blood pressure, cholesterol, and blood sugar levels should all be monitored. If they’re out of range, work with your doctor to get them back under control. […] On most days of the week, exercise for at least 30 minutes. […] Alcohol should be consumed in moderation or avoided entirely. […] Ask your GP what other preventive steps you should take based on your personal risk factors. […] Preventing small blood vessel injuries in the first place is the best method to avoid these issues. To control your blood pressure and cholesterol levels, eat a balanced diet, exercise regularly, and take the medication your doctor prescribes.

• #13

  https://www.foundmyfitness.com/topics/small-vessel-disease

  Low levels of plasma omega-3 polyunsaturated fatty acids were associated with more severe cerebral small vessel diseases in patients who had experienced an ischemic stroke. […] Participants with the highest serum concentration of vitamin D had fewer white matter hyperintensities, enlarged perivascular spaces, and total burden of small vessel disease. […] Greater visceral abdominal fat was independently associated with increased markers of cerebral small vessel disease in participants without a history of symptomatic cerebrovascular disease. […] Patients with hypertension have a greater burden of cerebral small vessel disease and are at greater risk of cognitive impairment, especially when presenting with progressive white matter hyperintensities.

• #14 Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01682-w

  Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases. However, the benefits of statin therapy for cerebral small vessel disease (CSVD), particularly in adults 75 years of age, have not been fully evaluated. […] Our findings indicated that statin therapy alleviated the progression of WMH, lacunes, and EPVS without elevating the risk of microbleeds. On the basis of the observed results, we concluded that statin therapy is an efficient and safe intervention for CSVD in adults 75 years of age. […] Statin therapy markedly ameliorated the risks of WMH, lacunes, and EPVS progression; and statin therapy had neither beneficial nor detrimental effects on microbleed progression. […] The results indicated that statin therapy, compared with non-statin therapy, was associated with a lower risk of WMH, lacunes, and EPVS progression. […] In conclusion, we found that statin therapy alleviated the progression of WMH, lacunes, and EPVS without elevating the risk of cerebral microbleeds in adults 75 years of age. Our findings indicated that statin therapy was an efficient and safe intervention for CSVD.

• #15 Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4832291/

  Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. […] Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. […] Potential prophylactic and treatment strategies might be those that target brain microvascular endothelium and the blood brain barrier, microvascular function and neuroinflammation. […] The slow development of SVD and its chronic nature suggest that any intervention for its prevention or treatment will need to be given longterm. […] Clinical targets include reducing first or recurrent stroke, and preventing cognitive decline and physical disabilities such as impaired balance or gait, or neuropsychological symptoms.

• #16 Prevention and Management of Cerebral Small Vessel Disease

  https://www.j-stroke.org/journal/view.php?number=73&viewtype=pubreader

  Hypertension is the most important risk factor for stroke, and the benefits of lowering BP are apparent in secondary stroke prevention. […] Therefore, it is appropriate to reduce the systolic BP to 130 mmHg in patients with lacunar infarction. […] However, the long-term effect of BP reductions remains uncertain, especially in old patients with extensive SVD. […] The results indicated a higher risk of sICH and PH after intravenous thrombolysis when multiple CMBs are present with a graded relationship to increasing baseline CMB number. […] Therefore, the use of t-PA should be cautious in patients with multiple CMBs. […] In this sense, the two drugs cilostazol and triflusal deserve attention. […] Therefore, cilostazol seems to be safer than aspirin in terms of the risk of hemorrhagic stroke in hypertensive patients with SVD. […] Future studies are needed to examine the appropriate target BP and cholesterol levels in patients with extensive SVD.

• #17 Thieme E-Journals – Seminars in Neurology / Abstract

  https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0037-1603468

  Cerebral small vessel disease can cause either ischemic stroke or intracerebral hemorrhage. […] Prevention should include the treatment of hypertension and diabetes, if present, and the modification of lifestyle factors such as obesity and poor nutrition. […] Patients with small subcortical ischemic strokes should be treated with antithrombotics; dual antiplatelet therapy may be more effective than aspirin for the first 3 weeks following acute stroke, but is not more effective than aspirin for long-term prevention. […] There is an unmet need for disease-modifying preventive therapies for cerebral amyloid angiopathy, the second most-common cause of spontaneous intracerebral hemorrhage.

• #18 Small Vessel Disease I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/cardiology/small-vessel-disease

  Small vessel disease is treated with medication to halt narrowing of the small blood vessels. […] Studies have shown that women with ongoing chest pain (even with normal main heart arteries) have a higher incidence of cardiac events than those without chest pain. […] Angiotension-converting enzyme (ACE) inhibitors, angiotension II receptor blockers (ARBS), statins, beta-blockers and aspirin therapy may be prescribed to treat small vessel disease.

• #19 NADPH Oxidase Activity in Cerebral Arterioles Is a Key Mediator of Cerebral Small Vessel Disease—Implications for Prevention

  https://www.mdpi.com/2227-9032/3/2/233

  Cerebral small vessel disease (SVD), a common feature of brain aging, is characterized by lacunar infarcts, microbleeds, leukoaraiosis, and a leaky blood-brain barrier. […] Inhibition of NADPH oxidase with phycocyanobilin from spirulina, as well as high-dose statin therapy, may have potential for prevention and control of SVD, and high-potassium diets merit study in this regard. […] With respect to the prevention or control of SVD, it may be useful to consider what measures could be employed to suppress the NADPH oxidase activity of cerebral arterioles. Statin therapy in an adequately high dose has the potential to inhibit NADPH oxidase activity by suppressing the isoprenylation of Rac, which plays a role in the assembly of NADPH oxidase complexes. […] Hence, it is reasonable to suspect that oral administration of whole spirulina, or spirulina extracts enriched in PhyCB, might be useful for preventing or controlling SVD.

• #20 Cerebral Small Vessel Disease Panel Test – PreventionGenetics

  https://www.preventiongenetics.com/testInfo?val=Cerebral-Small-Vessel-Disease-Panel

  This panel is recommended for patients suspected to have cerebral small vessel disease. […] Cerebral small vessel disease can be caused by defect in a number of genes with variable and overlapping presentations. This disease can be difficult to diagnose by clinical manifestation and image studies only. An accurate molecular diagnosis is critical for treatment, prognosis, prediction of recurrence risk, as well as future family plans. […] This panel contains genes causative for cerebral small vessel disease. Sensitivity varies depending upon the disorder. For example, in a study of 950 patients with lacunar stroke, the authors found the most common causes were NOTCH3 pathogenic variants (11 patients), followed by HTRA1 pathogenic variants (2 patients), and COL4A1 pathogenic variants (1 patient).

• #21 Brain Small Vessel Disease 2 via the COL4A2 Gene Test – PreventionGenetics

  https://www.preventiongenetics.com/testInfo?val=Brain-Small-Vessel-Disease-2-via-the-COL4A2-Gene

  COL4A2 sequencing is recommended for patients suspected to have brain small vessel disease 2. Targeted testing is indicated for family members of patients who have a known pathogenic variant in COL4A2. […] An accurate molecular diagnosis is critical for treatment, prognosis, and prediction of recurrence risk as well as future family planning. […] Analytical sensitivity of COL4A2 testing is high. However, brain small vessel disease caused by defects in COL4A2 is rare.

• #22 Importance of small vessel disease as a possible cause of sudden sensorineural hearing loss | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0302447

  Vascular disease like small-vessel disease (SVD) is the most likely cause among the potential causes of Sudden sensorineural hearing loss (SSNHL). Understanding the relationship between SVD and SSNHL is crucial for developing effective prevention and treatment strategies. […] The study identified SVD as a possible cause of SSNHL and found that the duration of SSNHL increased only in the presence of SVD. SVD also affected the recurrence of SSNHL, with the recurrence rate being 1.312 times higher in the group with SVD. […] The clinical implications of the association between SVD and SSNHL are significant, as they suggest that prevention, early detection, and treatment of vascular risk factors may help reduce the risk of SSNHL. One potential avenue for prevention is management of hypertension, which is a major risk factor for SVD.

• #23 Asymptomatic cerebral small vessel disease in adults with low cardiovascular risk | BMJ Neurology Open

  https://neurologyopen.bmj.com/content/5/1/e000356

  CV risk stratification through the HEARTS app has limited utility for predicting brain health in individuals with low CV risk. […] Identifying silent CSVD in individuals with apparently low CV risk is important, especially if they suffer from arterial hypertension. […] This study evidences the importance of timely detecting this condition, especially in hypertensive individuals, to avoid future neurological complications. […] The main result was the demonstration of asymptomatic CSVD even in subjects with low CV risk, and the independent association of age and hypertension with this condition. […] The multivariate analysis conducted in this study revealed an independent association of CV risk prediction and hypertension with the burden of global CSVD. […] The occurrence of lacunes in two patients with low CV risk constitutes a warning sign that cannot be overlooked. […] Thus, for individuals with LR, especially if they suffer from arterial hypertension, screening methods for asymptomatic CSVD at primary settings need to be developed, in order to establish more personalised attention to avoid serious neurological complications.

• #24 Beneath the Surface: Women’s Silent Struggle with Small Vessel Disease

  https://prevenciomed.com/2024/04/05/beneath-the-surface-womens-silent-struggle-with-small-vessel-disease/

  The battle against microvascular disease, particularly in women, is both multifaceted and continuous. Its not just about addressing the disease once it manifests but about understanding its precursors, actively working on prevention, and ensuring effective management. […] Prevention is better than cure isnt just a saying; its wisdom. […] Routine Medical Check-ups […] Annual Physical Examinations: Blood tests, blood pressure readings, and other vital checks can give an early indication of any potential issues. […] Advocating for Comprehensive Vascular Testing […] Echocardiograms and MRIs: These imaging tests provide a detailed look at the hearts structure and function, aiding in the identification of even subtle abnormalities. […] The brilliance of Prevencios tests lies in their non-intrusive nature and the wealth of actionable insights they provide. By enabling timely detection and preventive measures, they equip both patients and medical professionals with invaluable data, guiding informed healthcare decisions and proactive steps for safeguarding cardiovascular health.

• #25 Importance of small vessel disease as a possible cause of sudden sensorineural hearing loss | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0302447

  Early detection of SVD may be possible through imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT). These techniques can reveal signs of SVD in the brain, which may be early indicators of vascular pathology in other organs, including the inner ear. […] The treatment of SVD may involve a combination of lifestyle modifications and medication. Blood pressure-lowering medication, such as angiotensin-converting enzyme inhibitors and calcium channel blockers, may help prevent or slow the progression of SVD. Antiplatelet therapies, such as aspirin, may also be used to reduce the risk of thrombotic events associated with SVD. In addition, lifestyle modifications such as exercise, healthy diet, and smoking cessation may help reduce the risk of SVD and associated conditions such as SSNHL.

• #26 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology

  https://svn.bmj.com/content/1/3/83

  Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Single antiplatelet (for acute lacunar ischaemic stroke) and management of traditional risk factors still remain the most important therapeutic and preventive approach, due to limited understanding of pathophysiology in CSVD. […] Prevention and treatment of CSVD in the future should consider targeting the BBB, brain endothelium and microvascular function. […] Modification of traditional risk factors and a healthy lifestyle are currently the most important prophylactic and therapeutic approaches for CSVD indefinitely and until more specific treatments are available.

• #27

  https://link.springer.com/article/10.1007/s11655-022-3622-8

  Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. […] Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. […] Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. […] Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.

• #28 VBHI – Innovation & Prevention clinic – VBHI

  https://vbhi-institute.org/en/program/innovation-prevention-clinic/

  Next-generation prevention clinic for covert small cerebral vessel disease. […] The creation of the VBHI prevention clinic is a response to this lack of care. […] Firmly focused on prevention, these clinics will also enable innovation in the treatment of cerebral small vessel disease. […] Implementation of a new management circuit for patients presenting a covert form of cerebral small vessel disease, with a multidisciplinary approach, and removing the barriers (medical, socio-cultural, political, economic) for a paradigm shift towards earlier, more personalised prevention. […] Accelerating the transfer of research innovation for cerebral small vessel disease to patients. The prevention clinic will be setup to quickly evaluate the effectiveness, acceptability, tolerance and impact of new treatments and tools born from research. […] Cerebral small vessel disease, which is extremely common in the general elderly population, is one of the main causes of stroke (both infarction and cerebral haemorrhage), cognitive decline and dementia, as well as depression, problems with balance and walking and loss of independence.

• #29 Small Vessel Disease: Understanding Its Impact on Heart Health – Longmore Clinic

  https://longmoreclinic.org/small-vessel-disease-understanding-its-impact-on-heart-health/

  Small vessel disease is a serious condition that can lead to various complications, including heart attack, heart failure, or stroke. […] Preventing or managing small vessel disease involves addressing risk factors and adopting a heart-healthy lifestyle: […] Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. […] Exercise regularly. […] Maintain a healthy weight. […] Manage stress through activities like meditation, deep breathing, or yoga. […] Quit smoking. […] Control medical conditions like diabetes, high blood pressure, or high cholesterol. […] Small vessel disease is a serious condition that can have a significant impact on heart health. Understanding the causes, risk factors, and symptoms is essential for early diagnosis and effective management. By adopting a heart-healthy lifestyle and working with your healthcare provider, you can reduce your risk and improve your overall health.

• #30 Frontiers | Cerebral small vessel disease: Pathological mechanisms and potential therapeutic targets

  https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.961661/full

  Cerebral small vessel disease (CSVD) represents a diverse cluster of cerebrovascular diseases primarily affecting small arteries, capillaries, arterioles and venules. […] Still, due to the poor understanding of pathophysiology in CSVD, there is not an effective preventative or therapeutic approach for CSVD. The most widely accepted approach to CSVD treatment is to mitigate vascular risk factors and adopt a healthier lifestyle. […] Although the importance of and concern regarding CSVD is clearly recognized, there is a lack of effective prophylactic or therapeutic regimens. The current approach is management of vascular risk factors associated with CSVD including hypertension, smoking, diabetes, and hypercholesterolemia. […] Prevention and treatment of CSVD include lifestyle modifications such as smoking and pharmacologic interventions. Antiplatelet, anti-hypertensive and statin therapies are standard pharmacologic treatments.

• #31 Small Vessel Cerebrovascular Disease and Covert Cerebral Infarcts

  https://clinmedjournals.org/articles/jgmg/journal-of-geriatric-medicine-and-gerontology-jgmg-9-148.php?jid=jgmg

  Given that covert cortical infarcts represent larger vessel disease (as opposed to white matter hyperintensities and other radiological findings in small vessel disease) whether or not they present clinically, they should be considered for treatment with the same secondary prevention as an overt cerebral infarct (stroke) which presents with clear neurology. […] Overall controlling blood pressure and cholesterol within suggested clinical guidelines and encouraging healthy lifestyles are suggested, but given the lack of evidence of benefit in primary prevention and the risk of harm, antiplatelets are not recommended purely for small vessel disease.

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