Association Between Predicted 10-Year Atherosclerotic Cardiovascular Disease Risk and Magnetic Resonance Imaging-Defined Covert Brain Infarction

Covert brain infarction (CBI) is a clinically silent cerebrovascular lesion that doubles the risk of future stroke and is strongly associated with cognitive decline, 1-3 yet its detection depends almost exclusively on magnetic resonance imaging (MRI), which limits its feasibility for large-scale screening in asymptomatic populations.As a result, most individuals with covert cerebral ischemic injury remain unidentified until overt neurological events occur.The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score provides an integrated assessment of global vascular risk and is widely used in routine clinical practice to guide preventive care.4,5 Although ASCVD and CBI share overlapping vascular mechanisms, ASCVD scores were originally developed to predict overt macrovascular events rather than subclinical cerebral ischemic injury detectable on neuroimaging.Whether cumulative vascular risk captured by ASCVD estimation also reflects existing subclinical cerebrovascular injury remains unclear.In this community-based study, we investigated the association between 10-year ASCVD risk estimated by the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations and MRIdefined CBI in stroke-free middle-aged and older adults.This cross-sectional analysis was conducted within the commu-nity-based PRECISE (PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events) study (ClinicalTrials.govNCT03178448), which enrolled 3,067 adults aged 50-75 years from urban and rural communities in China.Standardized interviews, physical examinations, and laboratory testing were performed at baseline.6 The study protocol was approved by the ethics committees of Beijing Tiantan Hospital (KY2017-010-01) and Lishui Central Hospital (2016-42), and all participants provided written informed consent.The 10-year ASCVD risk was estimated using the PRE-VENT equations, including the base, urine albumin-creatinine ratio (UACR), and hemoglobin A1c (HbA1c) models.Participants were categorized into four risk strata (<5.0%, 5.0%-7.4%,7.5%-19.9%,and ≥20.0%).The PREVENT-base equation includes routinely collected clinical predictors, including age, sex, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, estimated glomerular filtration rate, history of diabetes, smoking status, and use of antihypertensive or lipid-lowering medications.The PREVENT-UACR equation additionally includes UACR, and the PREVENT-HbA1c equation additionally includes HbA1c.Risk categories were defined according to commonly used 10-year ASCVD risk thresholds for clinical risk stratification.All participants underwent 3.0 T brain MRI using a standardized protocol, and CBI was centrally as-