This study aims to assess the prevalence, risk factors, and clinical manifestations of CSVD. It places particular emphasis on characterizing its neuroimaging correlates. Detailed MRI analysis of CSVD will be conducted among patients at King Abdulaziz Medical City, Riyadh.

CSVD is a leading contributor to stroke, gait disturbance, and cognitive decline. Robust MRI-based epidemiology integrating vascular risks and medication exposures is limited in Middle East populations.

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.