Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis

Abstract

BackgroundIntracranial 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.MethodsThe 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.ResultsOf 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.ConclusionICAD 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.Study Registration NumberNCT02072876 2/25/2014

The association between ankle−brachial index and asymptomatic cranial‐carotid stenosis: a population‐based, cross‐sectional study of 5440 Han Chinese

“…However, they found no association between intracranial atherosclerosis and low ABI in the stroke patients, and hence suggested that a low ABI could be a predictor for ECAS but not ICAS. As expected, it was found that people with ACCS are older and have more vascular-related risk factors, similar to the reports from the other two studies [24,25].…”

Quality of life after stroke in Pakistan

“…Age, gender, educational status, occupation, marital status, family status was reported as demographic data. For socioeconomic indicators, World Bank Wealth index questionnaire was adopted [20]. Stroke survivors Medical complications, Post-stroke complications were noted at the time of interview [21] and stroke sub-types were evaluated through medical reports [22].…”

The Epidemiology of Stroke in a Developing Country (Pakistan)

“…In fact, the risk of stroke seems to have a continuous association with blood pressure down to levels as low as 115/75 mmHg [61]. In light of this, the national guidelines redefined categories of hypertension so that normal systolic blood pressure is < 120 mmHg and normal diastolic blood pressure is < 80 mmHg [66]. Most recently, it has been suggested that variability in blood pressure measurements (visit to visit, distinct measurements within a given visit) are associated with greater risk of stroke [67].…”