The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study

Abstract Cerebral small vessel disease (CSVD) is a major neurovascular contributor to stroke and cognitive impairment, yet its interaction with chronic high-altitude adaptation remains poorly understood. This first neuroimaging investigation examined 499 Tibetan natives residing at 2000–4800 m using...

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Main Authors: Shaoli Yao, Zhen-rong Qi, Shi-min Bao, Yi-yin Xing, Hui-ru Feng, Yuling Tan, Qi Zhang, Wei-hong Ge, Xiaorong Chen
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-09891-2
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author Shaoli Yao
Zhen-rong Qi
Shi-min Bao
Yi-yin Xing
Hui-ru Feng
Yuling Tan
Qi Zhang
Wei-hong Ge
Xiaorong Chen
author_facet Shaoli Yao
Zhen-rong Qi
Shi-min Bao
Yi-yin Xing
Hui-ru Feng
Yuling Tan
Qi Zhang
Wei-hong Ge
Xiaorong Chen
author_sort Shaoli Yao
collection DOAJ
description Abstract Cerebral small vessel disease (CSVD) is a major neurovascular contributor to stroke and cognitive impairment, yet its interaction with chronic high-altitude adaptation remains poorly understood. This first neuroimaging investigation examined 499 Tibetan natives residing at 2000–4800 m using 3 T MRI to quantify CSVD burden and to assess its association with residential altitude. Multivariable logistic regression, treating altitude as both a continuous variable (per 500 m increment) and a categorical variable (mid-high [2000–3500 m] vs. ultra-high [> 3500 m]), revealed that 51.5% of participants had CSVD (CSVD score ≥ 1), with adjusted odds ratios of 0.94 (95% CI: 0.74–1.21) per 500 m altitude and 0.78 (95% CI: 0.42–1.44) for ultra-high versus mid-high altitude. Partial proportional odds model showed no significant association between altitude and CSVD score (OR = 1.18, 95% CI 0.99–1.40). These null findings, in contrast to the well-established paradoxical impact of altitude on stroke risk, suggest potential neuroprotective mechanisms in altitude-adapted populations. Our results challenge conventional cerebrovascular paradigms and highlight the need for further research into Tibetan-specific genetic adaptations that may modulate CSVD pathophysiology. This study provides essential insights for refining altitude-related cerebrovascular risk models.
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spelling doaj-art-671d9f8c60ca4a0dbc09eac8d8836dd02025-08-20T04:01:23ZengNature PortfolioScientific Reports2045-23222025-07-0115111210.1038/s41598-025-09891-2The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional studyShaoli Yao0Zhen-rong Qi1Shi-min Bao2Yi-yin Xing3Hui-ru Feng4Yuling Tan5Qi Zhang6Wei-hong Ge7Xiaorong Chen8Department of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionDepartment of Neurology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionAbstract Cerebral small vessel disease (CSVD) is a major neurovascular contributor to stroke and cognitive impairment, yet its interaction with chronic high-altitude adaptation remains poorly understood. This first neuroimaging investigation examined 499 Tibetan natives residing at 2000–4800 m using 3 T MRI to quantify CSVD burden and to assess its association with residential altitude. Multivariable logistic regression, treating altitude as both a continuous variable (per 500 m increment) and a categorical variable (mid-high [2000–3500 m] vs. ultra-high [> 3500 m]), revealed that 51.5% of participants had CSVD (CSVD score ≥ 1), with adjusted odds ratios of 0.94 (95% CI: 0.74–1.21) per 500 m altitude and 0.78 (95% CI: 0.42–1.44) for ultra-high versus mid-high altitude. Partial proportional odds model showed no significant association between altitude and CSVD score (OR = 1.18, 95% CI 0.99–1.40). These null findings, in contrast to the well-established paradoxical impact of altitude on stroke risk, suggest potential neuroprotective mechanisms in altitude-adapted populations. Our results challenge conventional cerebrovascular paradigms and highlight the need for further research into Tibetan-specific genetic adaptations that may modulate CSVD pathophysiology. This study provides essential insights for refining altitude-related cerebrovascular risk models.https://doi.org/10.1038/s41598-025-09891-2CSVD burdenAltitudeTibetan PlateauObservational studyMRI biomarkersHigh-altitude adaptation
spellingShingle Shaoli Yao
Zhen-rong Qi
Shi-min Bao
Yi-yin Xing
Hui-ru Feng
Yuling Tan
Qi Zhang
Wei-hong Ge
Xiaorong Chen
The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
Scientific Reports
CSVD burden
Altitude
Tibetan Plateau
Observational study
MRI biomarkers
High-altitude adaptation
title The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
title_full The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
title_fullStr The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
title_full_unstemmed The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
title_short The association between altitude and cerebral small vessel disease burden in the Tibetan population: a cross-sectional study
title_sort association between altitude and cerebral small vessel disease burden in the tibetan population a cross sectional study
topic CSVD burden
Altitude
Tibetan Plateau
Observational study
MRI biomarkers
High-altitude adaptation
url https://doi.org/10.1038/s41598-025-09891-2
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