国家神经系统疾病临床医学研究中心数据管理与共享系统

发表杂志：J Atheroscler Thromb

发表类型: Clinical Study

影响因子(IF): 4.4

PMID: 3719795 Pubmed原文链接 全文下载

Intracranial atherosclerotic disease (ICAD) has been recognized as one of the most common causes of ischemic stroke and carries a high risk of stroke recurrence, especially in Asian. It is reported that, in Chinese populations, intracranial atherosclerosis accounts for about 33–50% of stroke and > 50% of TIA. Given this condition, the early identification and modification of risk factors for ICAD while patients are still asymptomatic, become more and more important in both primary and secondary stroke prevention in the general population. Albuminuria, defined by urine albumin-to-creatinine ratio (ACR) >30mg/g, is a surrogate of early damage of renal glomerulus and cardiovascular risk. Albuminuria has been well recognized as a risk factor for cardiovascular disease (CVD), carotid atherosclerosis and stroke. Recently, more attention has been paid to ACR below the normal range, defined as high-normal albuminuria. A large body of evidence supported that high-normal albuminuria is associated with increased CVD risks and carotid atherosclerosis for the general population and for individuals with hypertension or diabetes. However, much less is known about the relationship between albuminuria asymptomatic ICAD, which occurs more commonly in Asian. As compared with extracranial arteries, intracranial arteries have thinner media and adventitia without external elastic lamina and vasa vasorum . It is unclear whether the association between LGA and extracranial atherosclerosis can be generalized to intracranial arteries. To our knowledge, only three have reported abnormal albuminuria as a risk factor for asymptomatic ICAD . Among them, the ARIC study was the only community-based study assuring the independent role of albuminuria in ICAD. And so far, no one has focused on the association between high-normal albuminuria and asymptomatic ICAD. Hereby we conducted a cross-sectional analysis in a relatively low-risk community population free of stroke and CHD of the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study to explore the association of ACR and asymptomatic ICAD.

Subjects were stratified according to ACR tertiles. Incidence of ICAD, intracranial atherosclerosis burden and atherosclerotic lesion number were compared among all three ACR categories using the χ2 test. Adjusted odds ratios (OR)/ common odds ratio(cOR) and their 95% confidence intervals (CI) were estimated using logistic regression models to evaluate the association of ACR with the incidence of ICAD, intracranial atherosclerosis burden and atherosclerotic lesion number. Serial models were performed: 1) adjusted for age and sex; 2) additionally adjusted for history of hypertension, diabetes, smoking, alcohol, BMI, HDL, LDL, and HbA1c; 3) additionally adjusted for eGFR. Two tailed P values <0.05 were considered to be statistically significant.