title: Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis.
abstract: BACKGROUND
  Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.
  
  
  METHODS
  The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin-Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios.
  
  
  RESULTS
  Of the 200 participants, ICAD was found in 34.5% (n = 69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association.
  
  
  CONCLUSIONS
  ICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD.
  
  
  BACKGROUND
  NCT02072876 2/25/2014.
authors.forename: Ayeesha Kamran
authors.initials: AK
authors.lastname: Kamal
authors.forename: Farzin
authors.initials: F
authors.lastname: Majeed
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Hasan
authors.initials: H
authors.lastname: Rehman
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
authors.forename: Muhammad Saleem
authors.initials: MS
authors.lastname: Ilyas
authors.forename: Munawar
authors.initials: M
authors.lastname: Hussain
authors.forename: Kamran
authors.initials: K
authors.lastname: Masood
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Sumaira
authors.initials: S
authors.lastname: Nazir
authors.forename: Zafar
authors.initials: Z
authors.lastname: Sajjad
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors