title: Geographic and sex difference in the distribution of intracranial atherosclerosis in China.
abstract: OBJECTIVE
  Geographic variation and sex difference in the distribution of intracranial atherosclerosis (ICAS) have not been fully discussed before in Chinese patients with cerebral ischemia. We performed this study with the aim to investigate geographic and sex difference in the distribution of ICAS in China.
  
  
  METHODS
  In this prospective multicenter study, we evaluated 2864 consecutive patients who experienced an acute cerebral ischemia within 7 days of symptom onset in 22 hospitals in China. All the inclusive patients underwent 3-dimensional time-of-flight MR angiography and duplex color Doppler ultrasound or contrast-enhanced MR angiography to document the presence of intracranial or extracranial stenosis. Intracranial large-artery atherosclerosis was defined as ≥50% diameter reduction on MR angiography.
  
  
  RESULTS
  The proportion of patients with ICAS was significantly higher in north China than in south China (50.22% versus 41.88%; P<0.0001). Patients in the north were likely to consume more alcohol and smoke more cigarettes and had significantly higher proportion of diabetes mellitus, family history of stroke, history of cerebral ischemia, heart disease, and higher body mass index. In patients aged >63 years, the percentage of ICAS in women was notably higher than in men (51.51% versus 45.40%; P=0.028). In elderly patients, women had higher proportion of diabetes mellitus, hypertension, hyperlipidemia, and heart disease than men.
  
  
  CONCLUSIONS
  There exists geographic and sex difference in the distribution of symptomatic ICAS in China. Public health measures should strengthen improving social determinants of health and risk factor prevention/control in high-risk populations for decreasing stroke risk.
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital of Capital Medical University, Beijing, China.
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Pu
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xinying
authors.initials: X
authors.lastname: Zou
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.forename: Yannie
authors.initials: Y
authors.lastname: Soo
authors.forename: Thomas
authors.initials: T
authors.lastname: Leung
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000208:ethnology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D002681:China / Q000453:epidemiology / Q000208:ethnology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics; D012907:Smoking / Q000208:ethnology; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
keywords: geographic; intracranial stenosis; ischemic; sex differences; stroke