Increasing severity of cardiovascular risk factors with increasing middle cerebral artery stenotic involvement in type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease.
OBJECTIVE
To identify determinants associated with increasing severity of middle cerebral artery (MCA) stenosis in asymptomatic Chinese type 2 diabetic patients with and without MCA stenosis determined using transcranial Doppler. Conventional risk factors contribute to the pathogenesis of ischemic stroke, and differences in the pattern of these may explain the heterogeneity of disease presentation in different populations. In Chinese patients, MCA stenosis is the most commonly identified intracranial vascular lesion.


METHODS
Anthropometric and fasting biochemical parameters were compared between type 2 diabetic patients with MCA stenosis in one (n = 185) or both (n = 200) vessels and 1,492 type 2 diabetic patients without evidence of stenosis.


RESULTS
Increasing MCA stenotic vascular involvement was associated with significantly increasing age, duration of diabetes, systolic blood pressure, and LDL cholesterol, but with lower glucose levels. There was also an increased prevalence of hypertension, dyslipidemia, and use of blood pressure-and glucose-lowering agents in the patients with MCA stenosis. Concomitant significant increases in the prevalence of peripheral vascular disease and retinopathy were also observed in the patients with MCA stenosis.


CONCLUSIONS
Transcranial Doppler examination identified stenosis in one or both MCAs in over one-fifth of the Chinese type 2 diabetic subjects without symptoms of cerebrovascular disease. A number of conventional cardiovascular risk factors were closely associated with MCA stenosis. This technique may allow the identification of a particularly high-risk group, and further studies are required to determine whether asymptomatic MCA stenosis is predictive of primary cerebrovascular events and whether intensive treatment of risk factors would reduce the risk.
Thomas
G Neil
GN
Department of Medicine and Therapeutics, the Chinese University of Hong Kong, the Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China.
Lin
Jian Wen
JW
Lam
Wynnie W M
WW
Tomlinson
Brian
B
Yeung
Vincent
V
Chan
Juliana C N
JC
Liu
Roxanna
R
Wong
Ka Sing
KS
D001213:Asian; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D002539:Cerebral Arterial Diseases / Q000453:epidemiology* / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse; D012307:Risk Factors