This retrospective single-centre study included consecutive patients aged 40–70 years who underwent brain MRI over 12 months (N = 644). Patients were classified as CSVD-positive (≥1 STRIVE-defined marker) or CSVD-negative. MRI markers included white-matter hyperintensities (Fazekas grade), lacunes, perivascular spaces, and microbleeds. Patients with demyelinating disease, mass lesions, or other major white-matter disorders were excluded. Demographic, clinical, laboratory (hemoglobin, platelets, HbA1c, LDL), and medication data were extracted. Group differences used χ²/Fisher’s tests, and multivariable logistic regression identified factors associated with CSVD (α = 0.05).
Among 644 patients aged 40–70 years, 235 (36.5%) had MRI evidence of CSVD. Prevalence rose with age—18.2% at 40–50 years, 39.5% at 51–60, and 54.1% above 60 (P < 0.001)—with no sex difference. White-matter hyperintensities were the most frequent MRI feature, followed by lacunes, perivascular spaces, and microbleeds. CSVD was associated with hypertension, diabetes, chronic kidney disease, dyslipidemia, coronary artery disease, heart failure, and prior stroke/TIA (P ≤ 0.006). Among hypertensives, no therapy had the highest CSVD proportion (66.3%), whereas calcium-channel blockers had the lowest (23.7%, P < 0.001).
CSVD affected over one-third of adult patients and increased with age. Diabetes was the strongest correlate, while calcium-channel-blocker and antidiabetic therapy were inversely associated, likely reflecting better vascular and metabolic control. To our knowledge, this is the first MRI-based prevalence study of CSVD conducted in Saudi Arabia, provides regional insight into early vascular brain injury and supports targeted prevention strategies.