Ideal Cardiovascular Health Metrics on the Prevalence of Asymptomatic Intracranial Artery Stenosis: A Cross-Sectional Study

Qian Zhang,Xingquan Zhao,Jianwei Wu,Heng Zhou,Yong Zhou,Xiang Gao,Chunxue Wang,Shouling Wu,Liheng Bian,Shufeng Zhang,Anxin Wang,Rozemarijn Vliegenthart

doi:10.1371/journal.pone.0058923

Abstract

Background and PurposeIntracranial Artery Stenosis (ICAS) is one of the most common causes of ischemic stroke in Asia. Previous studies have shown the number of ideal cardiovascular health (CVH) metrics was associated with lower risk of stroke. This study aimed to investigate the relationship between ideal CVH metrics and prevalence of ICAS.MethodsA random sample of 5,412 participants (selected from Kailuan Study as a reference population) aged 40 years or older (40.10% women), free of stroke, transient ischemic attack, and coronary disease, were enrolled in the Asymptomatic Polyvascular Abnormalities Community study from 2010 to 2011. We collected information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose); and assessed ICAS by transcranial Doppler. The relationship between the ideal CVH metrics and prevalence of ICAS was analyzed using the multivariate logistic regression.ResultsAfter adjusting for age, sex, and other potential confounders, the adjusted odds ratios(95% confidence interval) for ICAS were 0.76(0.58–0.99), 0.55(0.43–0.72), 0.49(0.37–0.65), 0.43(0.31–0.61), and 0.36(0.22–0.62), respectively, for those having 2, 3, 4, 5, and 6–7 ideal CVH metrics compared with those having 0–1 ideal metric(p-trend<0.0001). Similar inverse associations were observed in different age and gender groups (all p-trends<0.05).ConclusionWe found a clear gradient relationship between the number of ideal CVH metrics and lower prevalence of ICAS in a Chinese population, which supports the importance of ideal health behaviors and factors in the prevention of ICAS.

Highlights

Intracranial arterial stenosis (ICAS) is one of the most common causes of stroke [1,2,3], which accounts for 8–10% of all cerebral ischemic events every year [4,5,6,7], and this proportion is higher in Asia
We did not observe any significant differences on family history of stroke between different numbers of ideal cardiovascular health (CVH) metrics
After adjusting for sex, age, education, income, family history of stroke, and the other six metrics, we found the ideal blood pressure or fasting blood glucose metric was significantly associated with the low prevalence of ICAS in any sex or age group, when compared with the non-ideal group, respectively

Summary

Introduction

Intracranial arterial stenosis (ICAS) is one of the most common causes of stroke [1,2,3], which accounts for 8–10% of all cerebral ischemic events every year [4,5,6,7], and this proportion is higher in Asia. ICAS was found in 33–37% of Chinese patients with ischemic stroke [8,9] and 51% of those with transient ischemic attack [10]. The reasons for such racial difference in distribution of intracranial and extracranial atherosclerosis remain uncertain [11]. The underlying concept of the AHA ideal CVH is ‘‘primordial prevention’’, which is distinctly different from ‘‘primary prevention’’ and designed to practice healthier behaviors, preventing the emergence of risk factors, rather than disease prevention [16]. Previous studies have shown the number of ideal cardiovascular health (CVH) metrics was associated with lower risk of stroke. This study aimed to investigate the relationship between ideal CVH metrics and prevalence of ICAS

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Methods

Results

Conclusion