Association Between Platelet and Cerebral Small Vessel Disease: A Secondary Analysis Based on a Retrospective Cross-Sectional Study in Korean Adults.

OBJECTIVE

This study aimed to explore an association between platelet count and moderate to severe cerebral white matter hyperintensities (MS-cWMH), a key imaging marker of cerebral small vessel disease (CSVD), in individuals with cardiovascular risk factors, hypothesizing that higher platelet counts are associated with increased CSVD severity.

METHODS

A retrospective cross-sectional study analyzed data from 1,011 participants aged ≥45 years at CHA Bundang Medical Center in Seoul, Korea, between 2008 and 2014. Participants were selected based on predefined criteria, including cardiovascular risk factors (e.g., hypertension, hyperlipidemia, smoking) and no history of stroke, and underwent brain MRI and MRA as part of the study protocol. Magnetic resonance angiography (MRA) was performed to exclude participants with large vessel disease, such as intracranial or extracranial arterial stenosis. A multivariable logistic regression model was constructed to assess the association between platelet count and MS-cWMH, incrementally adjusting for demographic characteristics, cardiovascular risk factors, and imaging features.

RESULTS

The study revealed a significant association between platelet count and MS-cWMH. Each increase of 100×10^9/L in platelet count was associated with a 1.37-fold increase in the risk of MS-cWMH (95% CI: 1.06-1.77, p = 0.0168). The association was more pronounced in females, elderly individuals aged 68-85 years, and patients with diabetes and remained robust in multiple sensitivity analyses.

CONCLUSION

Higher platelet counts are significantly associated with an increased risk of MS-cWMH, particularly in specific high-risk populations such as females, elderly individuals aged 68-85 years, and patients with diabetes. Platelet count may serve as a potential biomarker for assessing the risk of CSVD, aiding in the early identification of high-risk individuals for preventive interventions. This finding highlights the potential clinical significance of monitoring platelet counts in high-risk populations. Strategies to reduce high platelet counts, such as antiplatelet therapy (e.g., clopidogrel, aspirin) or lifestyle interventions (e.g., diet and exercise), may help mitigate the risk of MS-cWMH. Further longitudinal studies are needed to evaluate the effectiveness of these interventions in reducing MS-cWMH risk. Additionally, future research should investigate the biological mechanisms linking platelet count to CSVD, particularly the roles of platelet activation, inflammation, and endothelial dysfunction, to provide a more comprehensive understanding of this association.