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Zhang Z, Gao Y, Li Z, Li B, Gao S, Sun J, Tu J, Ning X, Zhang W, Wang J. Association of carotid atherosclerotic plaque and intima-media thickness with the monocyte to high-density lipoprotein cholesterol ratio among low-income residents of rural China: a population-based cross-sectional study. BMC Public Health 2023; 23:2541. [PMID: 38115018 PMCID: PMC10731795 DOI: 10.1186/s12889-023-17447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The monocytes to high-density lipoprotein cholesterol ratio (MHR) has been identified as a potential biomarker for cardiovascular and cerebrovascular diseases. In this population-based cross-sectional study, we explored the relationships among carotid artery disease (CAD), including the presence of carotid atherosclerotic plaque (CAP) and carotid artery intima-media thickness (CIMT), the MHR, and related parameter changes. METHODS This cross-sectional study, Conducted from April to June 2019 in a rural area of Tianjin, involved middle-aged and elderly participants. Based on carotid ultrasound examinations, participants were divided into CAP and non-CAP groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were utilized to assess MHR's predictive value for CAP. Gender-specific analyses were also performed to examine predictive variations. The relationship between CIMT and MHR was evaluated using linear regression. RESULTS Of the 2109 participants meeting the inclusion criteria, 51.6% were identified with CAP. Multivariate analysis revealed a significant association between MHR and CAP prevalence, (OR, 9.670; 95% CI, 2.359-39.631; P = 0.002), particularly in females (OR, 5.921; 95% CI, 1.823-19.231; P = 0.003), after adjusting for covariates. However, no significant correlation was found between CIMT and MHR when adjusted for other factors. The ROC analysis showed the area under the curve for MHR and CAP to be 0.569 (95% CI: 0.544-0.593; P < 0.001). CONCLUSIONS These findings suggested that it is crucial to enhance early screening and intervention for CAD, specifically focusing on the prevention and progression of CAP, to address the unique health challenges faced by low-income groups in rural settings. Emphasizing these preventive measures could significantly contribute to improving cardiovascular health outcomes in this vulnerable population.
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Affiliation(s)
- Zhen Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yannan Gao
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Zejian Li
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Bingyi Li
- School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi Province, 530000, China
| | - Shuai Gao
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jiayi Sun
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jun Tu
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
- Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, 154 Anshan Road, Tianjin, Heping District, 300052, China
- Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, China
| | - Xianjia Ning
- Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, China
| | - Wenjuan Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jinghua Wang
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China.
- Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, 154 Anshan Road, Tianjin, Heping District, 300052, China.
- Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, China.
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Mohammad Razali A, Mohamed Shafit MA, Md Saleh R, Mohmood A, Mohd Isa M. Ocular Ischemic Syndrome With Bilateral Carotid Artery Stenosis in a Patient With Chronic Tophaceous Gout. Cureus 2023; 15:e49270. [PMID: 38143638 PMCID: PMC10746868 DOI: 10.7759/cureus.49270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Ocular ischemic syndrome is a rare, blinding condition that usually presents rather late. This occurs mainly due to stenosis or occlusion of the carotid artery which supplies the ocular structures. Bilateral involvement may occur in one in five cases but may be asymmetrical. We report a case of a 72-year-old gentleman with bilateral ocular ischemic syndrome secondary to left common carotid artery total occlusion and severe right proximal internal carotid artery stenosis in a patient who is an active smoker with chronic tophaceous gout. His vision remained stable after a year of follow-up, with the main emphasis on optimizing his medical condition and smoking cessation.
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Affiliation(s)
- Amirah Mohammad Razali
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | | | - Rafidah Md Saleh
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Adzleen Mohmood
- Department of Ophthalmology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, MYS
| | - Mujammad Mohd Isa
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
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3
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Lin CJ, Chung CP, Liao NC, Chen PL, Chi NF, Lai YJ, Tang CW, Wu CH, Chang FC, Luo CB, Fay LY, Lin CF, Chou CH, Lee TH, Lee JT, Jeng JS, Lee IH. The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease. J Chin Med Assoc 2023; 86:697-714. [PMID: 37341526 DOI: 10.1097/jcma.0000000000000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, especially in Asian populations, which has a high risk of recurrent stroke and cardiovascular comorbidities. The present guidelines aim to provide updated evidence-based recommendations for diagnosis and management of patients with ICAD. Taiwan Stroke Society guideline consensus group developed recommendations for management of patients with ICAD via consensus meetings based on updated evidences. Each proposed class of recommendation and level of evidence was approved by all members of the group. The guidelines cover six topics, including (1) epidemiology and diagnostic evaluation of ICAD, (2) nonpharmacological management of ICAD, (3) medical therapy for symptomatic ICAD, (4) endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD, (5) endovascular interventional therapy for postacute symptomatic intracranial arterial stenosis, and (6) surgical treatment of chronic symptomatic intracranial arterial stenosis. Intensive medical treatment including antiplatelet therapy, risk factor control, and life style modification are essential for patients with ICAD.
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Affiliation(s)
- Chun-Jen Lin
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nien-Chen Liao
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Nai-Fang Chi
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Jun Lai
- Radiology Department, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chih-Wei Tang
- Neurology Department and Stroke Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Yu Fay
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Fu Lin
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Hsing Chou
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jiunn-Tay Lee
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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4
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Blecha M, DeJong M, Nam J, Penton A. Modifiable risk factors for occurrence of ipsilateral ischemic events after carotid endarterectomy beyond perioperative period. J Vasc Surg 2023; 77:538-547.e2. [PMID: 36181995 DOI: 10.1016/j.jvs.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this study was to quantify the effects of several modifiable variables on the occurrence of stroke after the initial perioperative period for patients who had undergone carotid endarterectomy (CEA). METHODS The primary outcome for the present study was the development of an ischemic stroke or transient ischemic attack (TIA) in the cerebral hemisphere ipsilateral to CEA after the initial hospitalization. All CEAs in the VQI between January 2003 and May 2022 were queried. We identified 171,816 CEAs in the database. The exclusion criteria for the study were the lack of follow-up data for >30 days, concomitant coronary artery bypass surgery, concomitant proximal or distal carotid intervention at CEA, other arterial interventions at CEA, and stroke or TIA during the initial hospital admission, leaving 126,290 patients for analysis. We used the χ2 test for statistical analysis of the outcome of ipsilateral ischemic stroke or TIA after the initial CEA hospital admission to determine the relevant variables. Age was evaluated as an ordinal variable using the Student t test. Variables with P ≤ .05 on univariable analysis were included in the multivariable Cox regression time-to-event analysis for the primary outcome. Kaplan-Meier curves were constructed of the most significant variables on Cox regression as a visual aid. RESULTS The following variables achieved significance on Cox regression for an association with development of ipsilateral hemispheric ischemic events after the index CEA hospital admission: lack of patch placement at CEA site (hazard ratio [HR], 18.24; P < .0001), lack of antiplatelet therapy at long-term follow-up (LTFU; HR, 9.75; P < .0001), lack of statin therapy at LTFU (HR, 3.18; P < .001), lack of statin therapy at hospital discharge (HR, 1.25; P = .015), anticoagulation at LTFU (HR, 1.53; P < .001), development of >70% recurrent stenosis (HR, 2.15; P < .001), and shunt use at surgery (HR, 1.20; P = .007). Patients with patch placement at surgery and patients with confirmed antiplatelet therapy at LTFU had had 99.8% and 99.6% freedom from an ischemic event ipsilateral to the side of the CEA at LTFU, respectively. This finding is in contrast to the 5.7% and 4.7% positivity for ischemic events for those without patch placement at surgery and those not receiving antiplatelet therapy at LTFU, respectively (P < .0001 for both). CONCLUSIONS Performance of patch angioplasty arterial closure was remarkably protective against ipsilateral cerebral ischemic events at LTFU after CEA. Discharging and maintaining patients with antiplatelet and statin medication after CEA significantly reduces the incidence of future ipsilateral ischemic events. Thus, a significant opportunity exists for enhanced outcomes with improved implementation of these measures.
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Affiliation(s)
- Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Loyola University Health System, Maywood, IL.
| | - Matthew DeJong
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Janice Nam
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Ashley Penton
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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5
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Kurian AL, Lucke-Wold B. Update on Management of Symptomatic Carotid Stenosis. JOURNAL OF NEUROSCIENCE AND NEUROLOGICAL SURGERY 2023; 13:255. [PMID: 37547058 PMCID: PMC10403258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Carotid artery stenosis (CAS) is one of the leading causes of cerebral ischemia and stroke.7 When plaque builds up in the internal carotid artery, it blocks blood flow to the brain. Oftentimes, this condition only comes to light after a patient experiences a stroke or stroke-like symptoms. When this occurs, cholesterol-lowering medications and blood thinners can help to increase blood flow to the brain. However, if the plaque is so large that it severely narrows the lumen of the artery, surgery may be required to restore blood flow to the brain. Patients with severe stenosis can undergo procedures such as carotid endarterectomies (CEA), stenting, and transcarotid artery revascularization (TCAR) for this purpose. In this review, we discuss these procedures and which patients warrant which type of intervention. We look at the pathophysiology of internal carotid artery stenosis and current treatment options, while highlighting emerging treatment options. This review aims to increase understanding of the management of symptomatic carotid artery stenosis as well as provide a groundwork for more innovative treatments.
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Affiliation(s)
- Annu L Kurian
- Florida State University College of Medicine, Tallahassee, U.S.A
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, U.S.A
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6
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Liu Z, Fan Q, Wu S, Lei Y. Associations of Monocytes and the Monocyte/High-Density Lipoprotein Ratio With Extracranial and Intracranial Atherosclerotic Stenosis. Front Neurol 2021; 12:756496. [PMID: 34925216 PMCID: PMC8678066 DOI: 10.3389/fneur.2021.756496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Although the monocyte/high-density lipoprotein ratio (MHR) has been shown to be a potential marker of inflammatory of cardiovascular and cerebrovascular diseases, there are few studies on its relationships with the degree of intracranial and extracranial atherosclerotic stenosis and the stenosis distribution. Methods: In total, 271 patients were admitted for digital subtraction angiography (DSA) examination and were classified into a non-stenosis group and a stenosis group. (1) The two groups were compared and the arteries were categorized according to the degree of intracranial or extracranial atherosclerotic stenosis (if ≥two branches were stenotic, the artery with the most severe stenosis was used). (2) Clinical baseline data and laboratory indexes of patients grouped according to stenosis location (intracranial vs. extracranial) were collected. Results: (1) MHR × 102 [odds ratio (OR) = 1.119, p < 0.001], age (OR = 1.057, p = 0.007), and lymphocyte count (OR = 0.273, p = 0.002) significantly affected the presence of cerebral atherosclerotic stenosis, with an MHR area of 0.82 under the receiver operating characteristic (ROC) curve (AUC) and an optimal diagnostic value of 0.486. Analyses of the moderate, mild, and severe stenosis groups showed that MHR × 102 (OR = 1.07, p < 0.001) significantly affected the severity of stenosis in patients. (2) In the analysis of stenosis at different sites, the rate of extracranial artery stenosis in patients who smoked (OR = 3.86, p = 0.023) and had a reduced lymphocyte level (OR = 0.202, p = 0.001) was remarkably greater than that in patients who smoked (OR = 3.86, p = 0.023). With increasing age, the rate of extracranial artery stenosis raised sharply. With the increase in the MHR level, the stenosis rate of each group was highly greater than that of the non-stenosis group. Conclusion: The MHR has a predictive value for the diagnosis of extracranial and intracranial atherosclerotic stenosis and is correlated with the degree and distribution of stenosis. Trial Registration: Clinical Medical Research Center Project of Qinghai Province (2017-SF-L1). Qinghai Provincial Health Commission Project (Grant #2020-wjzdx-29).
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Affiliation(s)
- Zhu Liu
- Qinghai Provincial People's Hospital, Xining, China
| | - Qingli Fan
- Qinghai Provincial People's Hospital, Xining, China
| | - Shizheng Wu
- Qinghai Provincial People's Hospital, Xining, China
| | - Yancheng Lei
- Qinghai Provincial People's Hospital, Xining, China
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7
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Mettananda KCD, Eshani MDP, Wettasinghe LM, Somaratne S, Nanayakkkara YP, Sathkorala W, Upasena A, Sirigampola C, Tilakaratna PMY, Pathmeswaran A, Ranawaka UK. Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients. BMC Neurol 2021; 21:385. [PMID: 34607563 PMCID: PMC8489097 DOI: 10.1186/s12883-021-02415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023] Open
Abstract
Background Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. Results A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. Conclusions Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.
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Affiliation(s)
- K C D Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka. .,Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - M D P Eshani
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - L M Wettasinghe
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Somaratne
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - W Sathkorala
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Upasena
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - C Sirigampola
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - P M Y Tilakaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Pathmeswaran
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - U K Ranawaka
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
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8
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Montes D, Vranic J, Lim JC, Song JW, Silverman SB, González RG, Romero J. Cardiovascular Risk Factors Affect Specific Segments of the Intracranial Vasculature in High-Resolution (HR) Vessel Wall Imaging (VWI). J Stroke Cerebrovasc Dis 2021; 30:106026. [PMID: 34407497 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Luminal-based imaging have identified different risk factors for extracranial and intracranial atherosclerosis (ICAS), but these techniques are known to underestimate the true extent of the disease. High-resolution (HR) vessel wall imaging (VWI) has recently gained recognition as a valuable tool in the assessment of ICAS. The aim of this study is to determine the association between cardiovascular risk factors and specific intracranial vessel segment involvement using HR-VWI. MATERIALS AND METHODS From January 2017 to January 2020, consecutive patients ≥ 18 years-old undergoing HR-VWI of the brain were identified. Patients with history of primary or secondary vasculitis, reversible cerebral vasoconstriction syndrome, or moya-moya were excluded. The presence of vessel wall thickening and enhancement were assessed in the perpendicular plane for each vessel segment by two neuroradiologists. Univariate and multivariate analyses were performed to assess associations between imaging findings and cardiovascular risk factors. Interrater reliability was calculated. RESULTS Seventy-one patients (39 men; mean age: 55.9 years) were included. Vessel wall enhancement was seen in 39/71 (55%). A total number of 105 vessel segments demonstrated abnormal enhancement and 79/105 (75%) had an eccentric pattern. Eccentric vessel wall enhancement was independently associated with age >65 years-old in the ICA (OR 9.0, CI 2.1 - 38.2, p < 0.01) and proximal MCA (OR 4.0, CI 1.2 - 13.2, p = 0.02), and with hyperlipidemia in the posterior circulation (OR 44.0, CI2.9-661.0, p<0.01). CONCLUSION There is a significant association between eccentric vessel wall enhancement of the ICA and proximal MCA in patients with age > 65; and of the proximal posterior circulation (basilar - PCA1) with hyperlipidemia.
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Affiliation(s)
- Daniel Montes
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US.
| | - Justin Vranic
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Jeewoo C Lim
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Jae W Song
- Department of Radiology, Division of Neuroradiology, Hospital of the University of Pennsylvania, PA, US
| | - Scott B Silverman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, US
| | - R Gilberto González
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
| | - Javier Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, US
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9
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Chen C, Wang X, Chen X, Ouyang M, Sun L, Arima H, Robinson T, Lindley RI, Chalmers J, Li G, Song L, Anderson CS. Disparities between Asian and Non-Asian Thrombolyzed Acute Ischemic Stroke Patients in the Enhanced Control of Hypertension and Thrombolysis Stroke Trial. Cerebrovasc Dis 2021; 50:560-566. [PMID: 34153968 DOI: 10.1159/000516487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE As outcomes for acute ischemic stroke (AIS) vary according to clinical profile and management approaches, we aimed to determine disparities in clinical outcomes between Asian and non-Asian participants of the international, Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED). METHODS ENCHANTED was a multicenter, prospective, partial-factorial, randomized, open trial of low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) alteplase, and intensive (target systolic blood pressure [SBP] 130-140 mm Hg) or guideline-recommended (<180 mm Hg) BP management, in thrombolysis-eligible AIS patients. Logistic regression models were used to examine the associations with outcomes of death or disability (modified Rankin scale [mRS] scores 2-6), major disability (mRS 3-5), death, and intracranial hemorrhage (ICH), with adjustment prognostic factors, alteplase dose, and mean SBP over 1-24 h. RESULTS Among 4,551 thrombolyzed AIS patients (mean age 66.7 years, 37.8% female), there were 65.4% Asians who were younger, fewer female, and with less atrial fibrillation, hypercholesterolemia, premorbid symptoms, and concomitant antihypertensive, antithrombotic and statin treatment, and more prior stroke, compared to non-Asians. Frequencies of hypertension, coronary artery disease, and diabetes mellitus were comparable between groups. Asian patients were less likely to be admitted to an acute stroke unit and receive early mobilization by a therapist or rehabilitation but more likely to receive intensive care. There were no significant differences between Asians and non-Asians in functional outcome (defined by mRS scores 2-6 or 3-5; adjusted odds ratio [OR] 1.00, 95% confidence interval [CI] 0.85-1.19 [p = 0.958] and OR 0.95, 95% CI 0.80-1.13 [p = 0.572], respectively), or death (OR 1.25, 95% CI 0.95-1.65; p = 0.116), despite Asians having greater odds of ICH (OR 1.51, 95% CI 1.23-1.86; p = 0.0001) and neurological deterioration within 24 h (OR 1.58, 95% CI 1.18-2.12; p = 0.002). CONCLUSIONS Within the context of an international clinical trial of thrombolyzed AIS patients, demography, risk factors, management, and odds of early neurological deterioration and ICH, all differ between Asian and non-Asian participants. However, patterns of functional recovery are similar between these major regional groups.
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Affiliation(s)
- Chen Chen
- Department of Neurology, East Hospital, Tongji University, Shanghai, China, .,The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia, .,The George Institute for Global Health at Peking University Health Science Center, Beijing, China,
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Xiaoying Chen
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Lingli Sun
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Hisatomi Arima
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Gang Li
- Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Lili Song
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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10
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AbuRahma AF, Avgerinos ED, Chang RW, Darling RC, Duncan AA, Forbes TL, Malas MB, Perler BA, Powell RJ, Rockman CB, Zhou W. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg 2021; 75:26S-98S. [PMID: 34153349 DOI: 10.1016/j.jvs.2021.04.074] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University-Charleston Division, Charleston, WV.
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, UPMC Hearrt & Vascular Institute, Pittsburgh, Pa
| | - Robert W Chang
- Vascular Surgery, Permanente Medical Group, San Francisco, Calif
| | | | - Audra A Duncan
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mahmoud B Malas
- Vascular & Endovascular Surgery, University of California San Diego, La Jolla, Calif
| | - Bruce Alan Perler
- Division of Vascular Surgery & Endovascular Therapy, Johns Hopkins, Baltimore, Md
| | | | - Caron B Rockman
- Division of Vascular Surgery, New York University Langone, New York, NY
| | - Wei Zhou
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz
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11
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Luchowski P, Szmygin M, Wojczal J, Prus K, Sojka M, Luchowska E, Rejdak K. Stroke patients from rural areas have lower chances for long-term good clinical outcome after mechanical thrombectomy. Clin Neurol Neurosurg 2021; 206:106687. [PMID: 34015697 DOI: 10.1016/j.clineuro.2021.106687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study evaluated 3-months clinical outcome after mechanical thrombectomy (MT) in stroke patients transferred to a comprehensive stroke center (CSC) from a rural and urban areas in a Lubelskie province, the third largest province in Poland. MATERIALS AND METHODS Acute stroke patients with a premorbid modified Rankin scale (mRS) score 0-2 who were admitted within 6 h after stroke onset and treated with MT between 2016 and 2020 were retrospectively analyzed. Patients from rural and urban areas transported directly to CSC were compared regarding the onset-to-groin time, reperfusion rate, symptomatic intracranial hemorrhage (sICH) and favourable clinical outcome (modified Rankin Scale score 0-2) 3-months after MT. RESULTS A total of 398 patients were analyzed: 179 from rural areas (RA) and 219 from urban areas (UA). There was no significant difference in baseline neurological deficit expressed in The National Institutes of Health Stroke Scale (median 18.4 for RA patients versus 18.1 for UA patients, p = 0.70). Time from stroke onset to groin puncture was significantly shorter in the UA patients (median 197.3 min versus 219.6 min, p = 0.004). There was a significant difference in 3 months favourable clinical outcome between these two groups (31.3% of RA patients versus 42.5% of UA patients, p = 0.021) and full recovery rates (5.6% of RA patients versus 15.0% of UA patients, p = 0.002). The rate of sICH and 3-months mortality was similar in both groups (7.3% of RA patients versus 8.7% of UA patients, p = 0.61% and 21.8% of RA group vs. 22.4% of UA group, p = 0.88, respectively). CONCLUSION Stroke patients from RA undergoing thrombectomy had worse functional outcome compared to UA patients. Since the benefit of MT is time dependent, urban-rural differences in stroke outcome probably result from the longer time from stroke onset to reperfusion treatment in RA patients.
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Affiliation(s)
- Piotr Luchowski
- Department of Neurology, Medical University of Lublin, Poland.
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Joanna Wojczal
- Department of Neurology, Medical University of Lublin, Poland
| | - Katarzyna Prus
- Department of Neurology, Medical University of Lublin, Poland
| | - Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
| | - Elżbieta Luchowska
- Department of Laboratory Diagnostics, Medical University of Lublin, Poland
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Poland
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12
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Abstract
Asymptomatic carotid stenosis (ACS) due to atherosclerosis is a risk factor for ipsilateral ischemic cerebrovascular events and cognitive impairment. The prognosis of ACS has improved over the past 4 decades due largely to improvements in medical management. Most patients with ACS can be managed without revascularization, but some patients with vulnerable plaque should be considered for revascularization. Regardless of the decision to refer for revascularization, all patients with ACS should receive intensive medical management. This includes lifestyle modification (Mediterranean diet, exercise, and smoking cessation) and pharmacological therapy (antiplatelets, lipid-lowering agents, blood pressure reduction, and glycemic control). Patients with ACS often have atherosclerosis in other critical locations, and thus optimal medical therapy is likely to reduce events outside the carotid arteries. The nature of optimal medical therapy is described.
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Affiliation(s)
- Daniel G Hackam
- Division of Clinical Pharmacology, Department of Medicine, Department of Clinical Neurological Sciences, and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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13
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Sun L, Song L, Yang J, Lindley RI, Robinson T, Lavados PM, Delcourt C, Arima H, Ovbiagele B, Chalmers J, Anderson CS, Wang X. Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study. Stroke Vasc Neurol 2021; 6:395-401. [PMID: 33526633 PMCID: PMC8485230 DOI: 10.1136/svn-2020-000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/12/2022] Open
Abstract
Background and purpose As studies vary in defining the prognostic significance of smoking in acute ischaemic stroke (AIS), we aimed to determine the relation of smoking and key outcomes in patient participants who had thrombolysed AIS of the international quasi-factorial randomised Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods Post-hoc analyses of ENCHANTED, an international quasi-factorial randomised evaluation of intravenous alteplase-dose comparison and levels of blood pressure control in patients who had thrombolysed AIS. Multivariable logistic regression models with inverse probability of treatment weighting (IPTW) propensity scores were used to determine associations of self-reported smoking status and clinical outcomes, according to 90-day modified Rankin Scale (mRS) scores and symptomatic intracerebral haemorrhage (sICH). Results Of 4540 patients who had an AIS, there were 1008 (22.2%) current smokers who were younger and predominantly male, with more comorbidities of hypertension, coronary artery disease, atrial fibrillation and diabetes mellitus, and greater baseline neurological impairment, compared with non-smokers. In univariate analysis, current smokers had a higher likelihood of a favourable shift in mRS scores (OR 0.88, 95% CI 0.77 to 0.99; p=0.038) but this association reversed in a fully adjusted model with IPTW (adjusted OR 1.15, 95% CI 1.04 to 1.28; p=0.009). A similar trend was also apparent for dichotomised poor outcome (mRS scores 2–6: OR 1.18, 95% CI 1.05 to 1.33; p=0.007), but not with the risk of sICH across standard criteria. Conclusion Smoking predicts poor functional recovery in patients who had thrombolysed AIS. Trial registration number NCT01422616.
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Affiliation(s)
- Lingli Sun
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China
| | - Lili Song
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jie Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Pablo M Lavados
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago de Chile, Region Metropolitana de S, Chile
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Bruce Ovbiagele
- San Francisco VA Healthcare System, University of California, San Francisco, California, USA
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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14
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Abstract
PURPOSE OF REVIEW Intracranial atherosclerosis (ICAS) is the most common cause of stroke throughout the world. It also increases the risk of recurrent stroke and dementia. As a complex and multifactorial disease, ICAS is influenced by multiple genetic, biological, and environmental factors. This review summarizes the candidate gene and genome-wide studies aimed at discovering genetic risk factors of ICAS. RECENT FINDINGS Numerous studies have focused on the association between single-nucleotide polymorphisms (SNPs) of atherosclerosis-related genes and the risk of ICAS. Variants in adiponectin Q (ADIPOQ), ring finger protein 213 (RNF213), apolipoprotein E (APOE), phosphodiesterase 4D (PDE4D), methylenetetrahydrofolate reductase (MTHFR), lipoprotein lipase (LPL), α-adducin (ADD1) genes, angiotensin-converting enzyme (ACE), and other genes related to renin-angiotensin-aldosterone system have been associated with ICAS. We review the available evidences on the candidate genes and SNPs associated with genetic susceptibility to ICAS, and point out future developments of this field. Genetic discoveries could have clinical implications for intracranial atherosclerotic disease.
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Affiliation(s)
- Minghua Liu
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA.
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15
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Saraf U, Prabhakaran S, Arun K, Babiker A, Rajendran A, Kesavadas C, Sylaja PN. Comparison of Risk Factors, Treatment, and Outcome in Patients with Symptomatic Intracranial Atherosclerotic Disease in India and the United States. Ann Indian Acad Neurol 2020; 23:265-269. [PMID: 32606510 PMCID: PMC7313562 DOI: 10.4103/aian.aian_549_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/01/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Intracranial atherosclerotic disease (ICAD) is common in the Asian population, but less studied in South Asians compared to East Asians. We compared risk factors, treatments, and outcomes among consecutive patients with symptomatic ICAD from India with a mixed-ethnic cohort from Chicago, Illinois. METHODS Consecutive patients with symptomatic ICAD were enrolled at 2 academic medical centers in Kerala, India and Chicago, United States. Data on demographics, risk factors, initial stroke severity (National Institute of Health Stroke Scale score [NIHSS]), recurrent stroke, and 3-month functional outcome (modified Rankin Scale [mRS]) were prospectively collected. Recurrent stroke was defined as symptomatic recurrence of focal neurologic deficits associated with radiographic evidence of new cerebral infarction within 3 months of index admission. RESULTS 329 patients (117 from Kerala, 212 from Chicago) were included. Indian patients were younger (61 vs. 68, P < 0.001), less frequently had prior stroke history (15.4 vs. 32.5%, P = 0.001) and coronary artery disease (11.1 vs. 22.2%, P = 0.013) but had higher initial NIHSS score (median 6 vs. 3, P < 0.001). Both groups received reperfusion therapy in similar proportions (8.5 vs. 7.1%, P = 0.630) but at discharge, 90.6% of Indian patients compared to 59.0% of Chicago patients were treated with dual antiplatelet therapy. More recurrent strokes occurred in Chicago patients (21.7 vs. 1.9%, P < 0.001) but functional outcome did not differ significantly. CONCLUSION Compared to patients in US with symptomatic ICAD, Indian patients were younger and had more severe strokes. However, Indian patients had lower rates of recurrent stroke, perhaps due to greater use of dual antiplatelet therapy.
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Affiliation(s)
- Udit Saraf
- Comprehensive Stroke Care Program, Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago Biological Sciences, Chicago, US
| | - K Arun
- Comprehensive Stroke Care Program, Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ahmed Babiker
- Department of Neurology, University of Chicago Biological Sciences, Chicago, US
| | - Adithyan Rajendran
- Imaging Sciences and Interventional Radiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Chandrasekharan Kesavadas
- Imaging Sciences and Interventional Radiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P N Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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16
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Krasteva MP, Lau KK, Mordasini P, Tsang ACO, Heldner MR. Intracranial Atherosclerotic Stenoses: Pathophysiology, Epidemiology, Risk Factors and Current Therapy Options. Adv Ther 2020; 37:1829-1865. [PMID: 32270364 PMCID: PMC7467483 DOI: 10.1007/s12325-020-01291-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 01/03/2023]
Abstract
Intracranial atherosclerotic stenoses (ICAS) are one of the most common causes of first and recurrent cerebrovascular ischaemic events worldwide, with highest prevalence in Asian, Hispanic and African populations. Clinical trials have improved the understanding of epidemiology, risk factors and imaging characteristics of patients with ICAS. Current therapeutic approaches concerning these patients include management of risk factors, best medical therapy, potentially endovascular and rarely surgical therapy. In our review, we elucidate the current epidemiology and evidence in evaluation of risk factors and therapeutic options for providing favourable outcome for patients with ICAS.
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Affiliation(s)
- Marina Petrova Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Anderson Chun On Tsang
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mirjam Rachel Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
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17
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Atherosclerotic calcification in major vessel beds in chronic obstructive pulmonary disease: The Rotterdam Study. Atherosclerosis 2019; 291:107-113. [DOI: 10.1016/j.atherosclerosis.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
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18
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Ji X, Leng XY, Dong Y, Ma YH, Xu W, Cao XP, Hou XH, Dong Q, Tan L, Yu JT. Modifiable risk factors for carotid atherosclerosis: a meta-analysis and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:632. [PMID: 31930033 DOI: 10.21037/atm.2019.10.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Carotid atherosclerosis is a major cause of stroke, but the conclusion about risk factors for carotid atherosclerosis is still controversial. The aim of our present meta-analysis and systematic review was to explore the modifiable risk factors for carotid atherosclerosis. Methods We searched PubMed from January 1962 to October 2018 to include longitudinal and cross-sectional studies. The results were pooled using random effects model. Heterogeneity was measured by I2 statistic and publication bias was assessed by funnel plots. Results A total of 14,700 articles were screened, of which 76 with 27 factors were eligible. Our meta-analysis of cross-sectional studies indicated nine factors (hyperlipidemia, hyperhomocysteinemia, hypertension, hyperuricemia, smoking, metabolic syndrome, hypertriglyceridemia, diabetes, and higher low density lipoprotein) were significantly associated with the presence of carotid plaque, among which four (hyperlipidemia, hyperhomocysteinemia, hypertension, and hyperuricemia) could elevate the risk of atherosclerosis by at least 50%; and one factor (hypertension) was associated with increased carotid intima-media thickness. In the systematic review, another five factors [negative emotion, socioeconomic strain, alcohol, air pollution, and obstructive sleep apnea syndrome (OSAS)] were also related to the presence of atherosclerosis. The cross-sectional associations with most of the above 14 factors were further confirmed by longitudinal studies. Among them, the managements of 4 factors (hypertension, hyperlipidemia, diabetes and OSAS) were indicated to prevent carotid atherosclerosis by cohort studies. Conclusions Effective interventions targeting pre-existing disease, negative emotion, lifestyle and diet may reduce the risk of carotid atherosclerosis. Further good-quality prospective studies are needed to confirm these findings.
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Affiliation(s)
- Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Xuchang People's Hospital, Xuchang 461000, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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19
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Qian Y, Ye D, Wu DJ, Feng C, Zeng Z, Ye L, Zhu R, Zhang Z, Mao Y. Role of cigarette smoking in the development of ischemic stroke and its subtypes: a Mendelian randomization study. Clin Epidemiol 2019; 11:725-731. [PMID: 31616189 PMCID: PMC6698606 DOI: 10.2147/clep.s215933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose Numerous studies have indicated that smokers have an increased risk of developing ischemic stroke. However, less is known about the causal relationship between cigarette smoking and ischemic stroke subtypes. In the present study, we aim to determine whether genetically predicted cigarette smoking was associated with subtypes of ischemic stroke using Mendelian randomization (MR). Patients and methods We used summary-level genetic association data from the MEGASTROKE consortium, including 438,847 individuals of European ancestry (34,217 cases of ischemic stroke and 404,630 controls). We used 176 single nucleotide polymorphisms as instrumental variables, which were previously identified to be associated with smoking in the Study of the Social Science Genetic Association Consortium (n=518,633). MR analyses were performed using inverse-variance-weighted method, weighted-median method, and MR-Egger regression. Results We found that genetically predicted smoking was associated with a higher risk of ischemic stroke (odds ratio (OR): 1.24, 95% CI: 1.10–1.39) and large artery ischemic stroke (OR: 1.52, 95% CI: 1.14–2.02), but not with risk of cardioembolic ischemic stroke or small vessel ischemic stroke. Sensitivity analyses using alternative MR approaches produced similar results. Conclusion Genetic predisposition toward smoking is causally associated with a higher incidence of large artery ischemic stroke. Further work is warranted to clarify the underlying mechanism of smoking in the development of large artery ischemic stroke.
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Affiliation(s)
- Yu Qian
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - Ding Ye
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - David Jh Wu
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China.,University of Minnesota Medical School , Minneapolis, MN 55455, USA
| | - Chen Feng
- The Second Clinical Medical College, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - Zhen Zeng
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - Lihong Ye
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - Rui Zhu
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
| | - Zhenyu Zhang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205, USA
| | - Yingying Mao
- School of Public Health, Zhejiang Chinese Medical University , Hangzhou, Zhejiang 310053, People's Republic of China
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20
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Song Y, Lee D, Suh DC, Kim JG, Kim JK, Han M, Liu H, Zhao L, Kim EH, Jung SC, Lee DG, Koo HJ, Kim MJ, Baek S, Hwang SM, Kim BJ, Kim YJ, Cho HJ, Kim SJ, Jeon SB, Kim JS. Cigarette Smoking Preferentially Affects Intracranial Vessels in Young Males: A Propensity-Score Matching Analysis. Neurointervention 2019; 14:43-52. [PMID: 30827064 PMCID: PMC6433193 DOI: 10.5469/neuroint.2018.01123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors. Materials and Methods All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups. Results Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup. Conclusion In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.
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Affiliation(s)
- Yunsun Song
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joong-Goo Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hairi Liu
- Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, China
| | - Lingbo Zhao
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Eun Hye Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung Chul Jung
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dong-Geun Lee
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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21
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Ji R, Yu K, Li G, Liu X, Yan Y, Gao S, Yang H, Qin S, Li F, Zhang G, Yang B, He Y, Zhao Y, Li E, Xu L, Zhang N, Fan D, Liu D. ECAS progression score: a web-based model to predict progression of extracranial carotid artery stenosis. Neurol Res 2019; 41:456-465. [PMID: 30759062 DOI: 10.1080/01616412.2019.1576375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE To develop and validate a risk model (Extracranial Carotid Artery Stenosis progression score, ECAS-PS) and to predict risk of ECAS progression. METHODS The ECAS-PS was developed based on the Renqiu Stroke Screening Study (RSSS), in which eligible participants were randomly divided into derivation (60%) and validation (40%) cohorts. ECAS at baseline and follow-up was diagosed by carotid duplex ultrasound according to the published criteria. ECAS progression was defined as an increase in ECAS to≥50% for those with a baseline of <50% or as an increase to a higher category of stenosis if the baseline stenosis was ≥50%. Independent predictors of ECAS progression were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test were used to assess model discrimination and calibration. RESULTS A total of 4111 participants were included and the mean age was 64.3. A total number of 29 (0.7%), 24 (0.6%) and 48 (1.2%) patients progressed during 2-year follow-up for left, right and bilateral (either left or right) carotid artery, respectively. The ECAS-PS was developed from a set of predictors of ECAS progression. The ECAS-PS demonstrated good discrimination in both the derivation and validation cohorts (AUROC range: 0.824-0.917). The Hosmer-Lemeshow tests of ECAS progression score were not significant in the derivation and validation cohorts (all P > 0.05). CONCLUSION The ECAS progression score is a valid model for predicting the risk of ECAS progression. Further validation of the ECAS-PS in different populations and larger samples is warranted.
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Affiliation(s)
- Ruijun Ji
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Kai Yu
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Guoyang Li
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Xinyu Liu
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Yinglin Yan
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Suying Gao
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Hongna Yang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Shangmin Qin
- h Department of Ultrasonography , Kangji Hospital , Hebei , China
| | - Fang Li
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Guangbo Zhang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Bo Yang
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Yan He
- j Department of Endocrinology , Kangji Hospital , Hebei , China
| | - Yongna Zhao
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Enjing Li
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Lihua Xu
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Na Zhang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Dongna Fan
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Dongliang Liu
- i Department of Cardiology , Kangji Hospital , Hebei , China
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Ma YH, Leng XY, Dong Y, Xu W, Cao XP, Ji X, Wang HF, Tan L, Yu JT. Risk factors for intracranial atherosclerosis: A systematic review and meta-analysis. Atherosclerosis 2018; 281:71-77. [PMID: 30658194 DOI: 10.1016/j.atherosclerosis.2018.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/13/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Intracranial atherosclerosis (ICAS) is a predictable and preventable condition, but existing evidence concerning its risk factors has not been quantitatively assessed. The aim of this meta-analysis is to identify the non-modifiable and modifiable risk factors for ICAS. METHODS PubMed and EMBASE were searched (1995-May 15, 2018) for cross-sectional and longitudinal studies exploring risk factors for ICAS. The risk estimates and 95% confidence intervals (CIs) in multivariate analysis were aggregated using random-effect models. RESULTS Thirty-four studies comprising 59,736 subjects met the inclusion criteria for the systematic review involving thirty-one risk or protective factors. Seven factors were associated with ICAS, as suggested by the meta-analysis, including advanced age (odds ratio (OR) 1.05, 95% CI 1.03-1.08), metabolic syndrome (OR 2.13, 95% CI 1.35-3.37), diabetes mellitus (OR 1.98, 95% CI 1.69-2.31), hypertension (OR 1.97, 95% CI 1.69-2.31), dyslipidemia (OR 1.29, 95% CI 1.04-1.59), high levels of low-density lipoprotein cholesterol (OR 1.06, 95% CI 1.00-1.12) and high levels of apolipoprotein A1 (OR 0.34, 95% CI 0.15-0.75). The subgroup analysis for study populations indicated advanced age, metabolic syndrome, diabetes mellitus and hypertension as an elevated risk of ICAS among community subjects and stroke patients; according to the subgroup analysis for ethnicity, similar associations remained in Asians, but only metabolic syndrome and diabetes mellitus were correlated with ICAS in Caucasians. CONCLUSIONS Individuals with advanced age, metabolic syndrome, diabetes mellitus, hypertension and dyslipidemia might have a higher risk of ICAS, whereas high levels of apolipoprotein A1 might protect against ICAS.
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Affiliation(s)
- Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
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