Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels.

Leung, Suet Yi; Ng, Tsz Wai; Yuen, Siu Tsan; Lauder, I.; Ho, Faith C. S.

doi:10.1161/01.str.24.6.779

Cited by 173 publications

(139 citation statements)

References 47 publications

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“…16,22 For example, the prevalence of intracranial compared with extracranial carotid disease varies among ethnic groups, with intracranial atherosclerosis more common in Asian and African populations and extracranial carotid and aortic arch atherosclerotic disease more common in white populations. 31,32 Therefore, a given pattern of atherosclerotic risk factors present in a population could result in different patterns of ischemic heart disease and stroke based on host factors alone.…”

Section: Other Factorsmentioning

confidence: 99%

Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease

2011

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Background-Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. Methods and Results-We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (PϽ0.001) and burden of disease (Pϭ0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. Conclusions-There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required. (Circulation. 2011; 124:314-323.)

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Section: Other Factorsmentioning

confidence: 99%

Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease

2011

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“…In particular, DM has been identified as a common vascular risk factor for ICS, even in different races 6, 14, 21, 25, 26. After multivariate logistic regression analysis, our study showed that DM was the most important determinant of IICS and an independent risk factor for both IICS and CEIS but not for IECS (Table 2, Figure 3).…”

Section: Discussionmentioning

confidence: 61%

“…Several risk factors, such as age, HTN, hyperlipidemia, metabolic syndrome, smoking, and DM, are regarded as major contributors to ICS 1, 6, 12, 13, 14. In particular, DM has been identified as a common vascular risk factor for ICS, even in different races 6, 14, 21, 25, 26.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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BackgroundIntracranial stenosis (ICS) is a major determinant of ischemic stroke in Asians. We determined the clinical significance of different risk factors and the role of ICS in Taiwanese patients with varied distributions of cervicocerebral stenosis.Methods and ResultsPresence of extracranial carotid stenosis (ECS, ≥70%) and ICS (>50%) was examined in 13 539 patients using ultrasonography and magnetic resonance angiography, respectively. Seven hundred thirty‐three patients with non‐ECS/ICS (n=372), isolated ICS (n=112), isolated ECS (n=121), or combined ECS/ICS (CEIS, n=128) were selected. Prevalence of ischemic stroke in each group was compared, and risk factors for stenosis were determined. The area under the receiver operating characteristic curve for each risk factor was calculated. Prevalence of ischemic stroke was highest in patients with CEIS (odds ratio 15.86; P<0.001), followed in decreasing order by those with isolated ICS (odds ratio 7.16; P<0.001), isolated ECS (odds ratio 1.77; P=0.011), and non‐ECS/ICS. Multivariate logistic regression analysis revealed that hypertension, coronary artery disease, and smoking were risk factors for isolated ECS; hypertension, diabetes mellitus, coronary artery disease, and smoking were risk factors for isolated ICS; and diabetes mellitus, coronary artery disease, and smoking were risk factors for CEIS. Smoking, diabetes mellitus, and coronary artery disease were the greatest contributors to CEIS, isolated ICS, and isolated ECS, respectively.ConclusionsCEIS was associated with higher odds of ischemic stroke compared with isolated ICS and isolated ECS. Smoking and diabetes mellitus, major determinants of CEIS and isolated ICS, should be targeted in therapeutic strategies to reduce the risk of ischemic stroke.

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“…These findings are consistent with previous reports that showed diabetes mellitus to be preferentially associated with intracranial stenosis. An autopsybased study from Hong Kong reported an increased prevalence of intracranial stenosis in deceased patients with a past medical history of diabetes mellitus 23 . Bae et al showed that in patients with asymptomatic intracranial stenosis, diabetes mellitus was 1.86 times more likely to be present 9 .…”

Section: Discussionmentioning

confidence: 99%

Diabetes, Intracranial Stenosis and Microemboli in Asymptomatic Carotid Stenosis

Lam

Lammers

Munoz³

et al. 2013

Can. J. Neurol. Sci.

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With more intensive medical therapy, the risk of stroke or death in patients with asymptomatic carotid stenosis is now so low that most patients will not benefit from endarterectomy or stenting 1 . It is therefore important to have methods to identify the small proportion who could benefit from intervention 1,2 , or who may require special consideration in choice of medical therapy. We have previously reported that carotid plaque area 3 , microemboli on transcranial Doppler 4,5 (TCD), and carotid plaque ulceration on 3-dimensional ultrasound 5 predict the risk of cardiovascular events, particularly of stroke. The predictive value of TCD microembolus detection in patients with ABSTRACT: Background: The risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now so low that it is important to have methods to identify those patients most likely to benefit from intervention, or who may require special consideration in choice of medical therapy. We studied the prediction of stroke, death or transient ischemic attacks (stroke/death/TIA) in patients with ACS by intracranial arterial stenosis, and microemboli on transcranial Doppler (TCD), and the effect of diabetes mellitus on microemboli, intracranial stenosis and risk of events. Methods: Patients with ACS > 60% by Doppler ultrasound were recruited from the Stroke Prevention Clinic of University Hospital, London, Canada. All 339 participants underwent TCD for detection of intracranial stenosis and detection of microemboli, and carotid ultrasound to measure extracranial stenosis and total carotid plaque area. Participants were followed for three years, to determine the risk of stroke/death/TIA. Results: Stroke/death/TIA occurred in 38% of patients with microemboli versus 10% without (p=0.0001), and in 18% of patients with intracranial stenosis, versus 10% without (p=0.042). Diabetics were significantly more likely to have intracranial stenosis (45% vs. 29%, p =0.014), microemboli (38% vs. 10%, p <0.0001), and had significantly higher risk of stroke/death/TIA over three years (21% vs. 11% without; p=0.024). Survival free of stroke, TIA or death was significantly better without microemboli or intracranial stenosis (p<0.0001). Conclusions: Diabetes, microemboli and intracranial stenosis predicted higher risk of stroke, death or TIA than did extracranial stenosis or total plaque area; diabetics may need more intensive therapy.RÉSUMÉ: Diabète, sténose intracrânienne et microembolies dans la sténose carotidienne asymptomatique. Contexte : Le risque d'accident vasculaire cérébral (AvC) chez les patients porteurs d'une sténose carotidienne asymptomatique (SCA) est maintenant si faible qu'il est important d'établir des critères pour identifier les patients qui sont les plus susceptibles de bénéficier d'une intervention ou chez qui on doit porter une attention particulière au choix du traitement médical. nous avons examiné si la présence d'une sténose artérielle intracrânienne et de microembolies au Doppler transcrânien (DTC) étaient des facteurs de prédiction de ...

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Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels.

Cited by 173 publications

References 47 publications

Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease

Global Variation in the Relative Burden of Stroke and Ischemic Heart Disease

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Diabetes, Intracranial Stenosis and Microemboli in Asymptomatic Carotid Stenosis

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