Abstract: Objective To investigate the association between cardiovascular health (CVH) behaviors and the total burden of cerebral small vessel disease (CSVD) in middle-aged and elderly patients in the Panzhihua region. Methods A cohort of stable middle-aged and elderly patients with CSVD, who were followed up at the neurology outpatient clinic of Panzhihua Second People's Hospital between January 2024 and December 2025, was selected for this study. All participants underwent cranial magnetic resonance imaging to assess the total CSVD burden score. Based on this score, patients were categorized into a low-to-moderate burden group (0-2 points) and a severe burden group (3-4 points). Cardiovascular Health (CVH) scores were evaluated for all participants. A multivariate logistic regression model was employed to analyze the association between CVH scores and the risk of total CSVD burden in this patient population. Results The final analysis included 826 middle-aged and elderly patients with CSVD, of whom 506 were in the low-to-moderate burden group and 320 were in the severe burden group. After adjusting for confounding factors such as age, history of coronary heart disease, and history of stroke, logistic regression analysis revealed that smoking status (OR=0.368), sleep quality (OR=0.298), lipid levels (OR=0.256), blood glucose levels (OR=0.375), and blood pressure control (OR=0.279) were significantly associated with the total CSVD burden. Compared to the low CVH subgroup, the risks of severe CSVD burden were substantially lower in the medium and high CVH subgroups. Furthermore, a trend test indicated that as the CVH score increased, the risk of severe CSVD burden progressively decreased (P for trend <0.01). Conclusion In the middle-aged and elderly CSVD population of the Panzhihua region, there is a negative correlation between the CVH score and the total CSVD burden. A lower CVH score is associated with a higher total burden of the disease, suggesting that the CVH score is an independent factor influencing the total CSVD burden. These findings indicate that maintaining good cardiovascular health is beneficial for reducing the total burden of CSVD.

Key words: Middle-aged and elderly, Cerebral small vessel disease, Total burden, Cardiovascular health score