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Cerebral small vessel disease (CSVD) is an important cause of stroke and dementia. Recent evidence showed that coronary artery calcium (CAC), a robust measure of subclinical atherosclerosis, independently predicts future dementia. One potential explanation for this observed link between CAC and dementia is that CAC is related to CSVD. However, limited study directly examined such association.Aim: To provide mechanistic explanation for the already-observed positive association between atherosclerosis and dementia.Methods: A total of 702 community dwelling men randomly sampled from Kusatsu City, Japan were analyzed. CAC was scored by Agatston’s method. Using MRI (magnetic resonance imaging) we assessed the following components as the measures of CSVD: lacunar infarcts (LI), microbleeds (MB), deep and subcortical white matter hyperintensity (DSWMH) and periventricular hyperintensity (PVH). CAC were categorized as absent (Agatston score=0), mild (more than zero and <100) and moderate to severe (≥100). The associations were assessed by binomial logistic regression analyses. Age (at the time of MRI examination), ever smoker, hypertension, diabetes mellitus and dyslipidemia were used as risk factors covariates. P trends were performed treating CAC category as ordinal.Results: Mean age of the participants was 69.7± 8.8 years. Prevalence of CSVD components was significantly higher in groups with higher CAC. LI was significantly associated with mild and moderate-to-severe CAC groups in unadjusted, age and risk factors adjusted analyses. Moreover, DSWMH was significantly associated with moderate-to-severe CAC group in unadjusted analysis as well as in age and risk factors adjusted analyses. But, MB and PVH were significantly associated with mild and moderate-to-severe CAC groups only in unadjusted analysis. After age and risk factors adjusted analyses the associations were no longer significant. Trend for a dose-response relation of CAC with LI and DSWMH were significant in unadjusted, age and risk factors adjusted analyses, but for MB and PVH, trends were significant only in unadjusted analysis. In Conclusion, those with higher CAC were associated with higher odds of having LI and DSWMH. Presence and degree of CAC may be useful in predicting CSVD.