ObjectiveCushing's syndrome (CS) is associated with high cardiovascular risk. White matter lesions (WML) are common on brain magnetic resonance imaging (MRI) in patients with increased cardiovascular risk.AimTo investigate the relationship between cardiovascular risk, WML, neuropsychological performance and brain volume in CS.Design/methodsThirty-eight patients with CS (23 in remission, 15 active) and 38 controls sex-, age- and education-level matched underwent a neuropsychological and clinical evaluation, blood and urine tests and 3Tesla brain MRI. WML were analysed with the Scheltens scale. Ten-year cardiovascular risk (10CVR) and vascular age (VA) were calculated according to an algorithm based on the Framingham heart study.ResultsPatients in remission had a higher degree of WML than controls and active patients (P<0.001 andP=0.008 respectively), which did not correlate with cognitive performance in any group. WML severity positively correlated with diastolic blood pressure (r=0.659,P=0.001) and duration of hypertension (r=0.478,P=0.021) in patients in remission. Both patient groups (active and in remission) had higher 10CVR (P=0.030,P=0.041) and VA than controls (P=0.013,P=0.039). Neither the 10CVR nor the VA correlated with WML, although both negatively correlated with cognitive function and brain volume in patients in remission (P<0.05). Total brain volume and grey matter volume in both CS patient groups were reduced compared to controls (total volume: activeP=0.006, in remissionP=0.012; grey matter: activeP=0.001, in remissionP=0.003), with no differences in white matter volume between groups.ConclusionsPatients in remission of Cushing's syndrome (but not active patients) have more severe white matter lesions than controls, positively correlated with diastolic pressure and duration of hypertension. Ten-year cardiovascular risk and vascular age appear to be negatively correlated with the cognitive function and brain volume in patients in remission of Cushing's syndrome.