Blood Pressure Mediates the Association Between Carotid‐Femoral Pulse Wave Velocity and Basal Ganglia Enlarged Perivascular Spaces: A Community‐Based Cross‐Sectional Study

Abstract

Although carotid‐femoral pulse wave velocity (cf‐PWV) is the non‐invasive gold standard for assessing aortic stiffness, evidence linking cf‐PWV to basal ganglia enlarged perivascular spaces (BG‐EPVS) in the general population is limited. We aimed to evaluate this association and quantify the mediating role of blood pressure (BP) in community‐based adults. This cross‐sectional study included 485 participants from the Kailuan cohort. Cf‐PWV was measured by ultrasound, and BG‐EPVS were graded on 3.0‐Tesla MRI. Logistic regression, restricted cubic spline, and mediation analyses were applied to quantify the indirect effects of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP). BG‐EPVS were identified in 59.4% of participants. After adjustment for cardiovascular risk factors other than BP, cf‐PWV ≥ 10 m/s was independently associated with BG‐EPVS (OR = 2.06, 95% CI: 1.27–3.36), with a linear dose‐response relationship (p for non‐linearity = 0.668). The association was stronger among participants aged ≤ 70 years and among males. SBP and PP mediated 43.0% and 43.6% of the total cf‐PWV effect, respectively, whereas DBP did not function as a significant mediator. Higher cf‐PWV was independently and dose‐dependently associated with BG‐EPVS, with pulsatile BP components mediating approximately 43% of this association.