title: Blood Pressure Is the Determinant for the Increased Risk for Intracranial Arterial Stenosis in Subjects with Elevated Glycated Hemoglobin Levels: The Kangbuk Samsung Health Study.
abstract: OBJECTIVE
  Ischemic stroke is known to be an important vascular complication of diabetes. Intracranial arterial stenosis (ICAS) is considered as an important cause of stroke in Asians. We aimed to analyze the risk for ICAS assessed by transcranial Doppler (TCD) ultrasonography in different groups of young Korean subjects divided by glycated hemoglobin (HbA1c) levels.
  
  
  METHODS
  This study included 10,437 participants without history of cardiovascular diseases (81.3% men, mean age 43 years) from a health screening program, in whom TCD ultrasonography was used to detect greater than 50% ICAS based on criteria modified from the SONIA (Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis) trial. The subjects were divided into 3 groups according to HbA1c levels: HbA1c < 5.7%, 5.7 ≤ HbA1c < 6.5%, and HbA1c ≥ 6.5% or under medication for diabetes.
  
  
  RESULTS
  Among the participants, 3.0% of the subjects had ICAS. The subjects with ICAS tended to have higher mean HbA1c level compared with those without ICAS (5.8 ± .8 versus 5.7 ± .6, P = .063). The proportion of subjects with ICAS significantly increased as the HbA1c increased from the first to the third group (2.8%, 3.0%, 4.6%, P for linear trend = .022). In logistic regression analysis with ICAS as the dependent variable, the group with HbA1c ≥ 6.5% showed significantly increased odds ratio for ICAS with subjects with HbA1c < 5.7% as the reference after adjustment for confounding variables (1.575, 95% confidence interval 1.056-2.347). However, this significance disappeared with inclusion of presence of hypertension in the model.
  
  
  CONCLUSIONS
  The risk for ICAS assessed by TCD was increased in young Korean subjects with HbA1c ≥ 6.5%. However, this significance was attenuated after adjustment for presence of hypertension, suggesting the importance of hypertension in ICAS.
authors: Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
authors: Hyung-Geun
authors: HG
authors: Oh
authors: Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hongsiri@hanmail.net.
authors: Eun-Jung
authors: EJ
authors: Rhee
mesh_terms: D000328:Adult; D000367:Age Factors; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D020765:Intracranial Arterial Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Intracranial arterial stenosis; diabetes; glycated hemoglobin; transcranial Doppler sonogram