Abstract Number: Esoc2026a694 Vascular Brain Injury and Stroke Risk Scores: Cross-Sectional Neuroimaging Analysis in a Healthy Cohort

Abstract Background and aims Current stroke risk scores are well established in predicting future symptomatic stroke. However, it remains unclear whether they also reflect underlying brain health and asymptomatic vascular injury. Methods We analyzed 293 healthy adults (mean age 65.2 ± 6.0 years; 30.4% male) who underwent stroke risk assessments and MRI scans. Imaging biomarkers included brain parenchymal fraction (BPF), white matter hyperintensity (WMH) volume, cortical thickness, cerebral microbleeds (CMBs), and silent infarcts. Five- and ten-year stroke risks were estimated using QStroke and the revised Framingham Stroke Risk Profile (rFSRP). Associations were evaluated using linear and logistic regression with additional analyses adjusting for vascular risk factors. Results Higher QStroke scores were associated with lower BPF (β=-0.016−-0.017), greater WMH burden (β=1.57−1.60), and higher odds of cerebral microbleeds and silent infarcts (OR=2.33−2.68; all p0.001). Consistent associations were observed in ten-year rFSRP with higher score linked to lower BPF (β=-0.011), higher WMH (β=1.021), and higher microbleeds and asymptomatic infarcts (OR=1.92–2.41; p0.001). These relationships paralleled associations observed between MRI markers and individual vascular risk factors, especially age and hypertension. Associations remained present across age groups, with no interaction between age and scores, and were similar across low- and high-risk groups, supporting that risk scores capture cumulative vascular burden. Conclusions Stroke risk scores not only reveal future stroke risk but also underlying asymptomatic cerebrovascular injury and overall brain health. Associations with brain atrophy, WMH burden, and silent vascular lesions suggest that these conventional tools may capture underlying silent stroke burden, even in otherwise healthy adults. Conflict of interest Arp-Arpa Kasemsantitham: nothing to disclose. Stephen J. Kerr: nothing to disclose. Sasitorn Petcharunpaisan: nothing to disclose. Supaporn Krittanupong: nothing to disclose. Nijasri Charnnarong Suwanwela: nothing to disclose. Naruchorn Kijpaisalratana: nothing to disclose.