title: Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study.
abstract: OBJECTIVE
  To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes.
  
  
  METHODS
  In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death.
  
  
  RESULTS
  Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03).
  
  
  CONCLUSIONS
  Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.
authors.affiliation: Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Jian Gang
authors.initials: JG
authors.lastname: Duan
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Xiang Yan
authors.initials: XY
authors.lastname: Chen
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Alex
authors.initials: A
authors.lastname: Lau
authors.affiliation: Department of Psychological Studies and Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong SAR, China.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
authors.forename: G Neil
authors.initials: GN
authors.lastname: Thomas
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Brian
authors.initials: B
authors.lastname: Tomlinson
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Roxanna
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications*; D011446:Prospective Studies; D012306:Risk