Middle cerebral artery stenosis increased the risk of vascular disease mortality among type 2 diabetic patients
G Neil Thomas1, Xiang-Yan Chen, Jian Wen Lin
1Department of Community Medicine, University of Hong Kong, Pokfulam, Hong Kong, SAR, PR China.
Background:
In Chinese populations, middle cerebral artery (MCA) stenosis is the most commonly identified intracranial vascular lesion, and has been shown to be associated with an increased risk of secondary stroke mortality, but has yet to be reported for primary events. We assess whether asymptomatic MCA stenosis is associated with mortality in Chinese type 2 diabetic patients.
Methods:
The presence of MCA stenosis was determined by transcranial Doppler and mortality data were collated in the Hong Kong Death Registry. Cox proportional hazards regression was used to determine if the MCA stenosis (n = 272, 53.7% 2-vessel disease) in 2,197 diabetics was associated with all-cause or vascular disease mortality, including after adjustment for conventional vascular risk factors. Anthropometric and fasting biochemical parameters were compared between diabetic patients with MCA stenosis and without evidence of stenosis.
Results:
A total of 191 deaths were identified (30.9% of vascular disease origin) during a follow-up of 18,279 patient years over 8.32 years. After adjustment for age, gender and diabetes duration, the hazard ratios for vascular mortality for 1- and 2-vessel disease were 2.47 (95% CI = 1.13-5.38) and 4.47 (95% CI = 2.24-8.82), p < 0.001 for trend, for increasing vascular mortality with increasing severity of cerebrovascular involvement, but 0.81 (95% CI = 0.45-1.47) and 2.23 (95% CI = 1.45-1.47), p = 0.001 for trend, for all-cause mortality. For vascular mortality, further adjustments for anthropometric and fasting biochemical parameters, or existing disease and treatment history increased the hazard ratios for 1-vessel disease slightly but attenuated the risk for 2-vessel disease evidently, 2.81 (95% CI = 1.10-7.16) and 2.85 (95% = CI 1.11-7.33), p = 0.026.
Conclusion:
The presence of MCA stenoses was an independent predictor of vascular mortality in these diabetics. More aggressive treatment of risk factors in these subjects merits further evaluation.
Insights
Asymptomatic middle cerebral artery (MCA) stenosis is a significant predictor of vascular mortality in Chinese type 2 diabetic patients. Early detection and aggressive risk factor management are crucial for this population.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Diabetology
Background:
- Middle cerebral artery (MCA) stenosis is common in Chinese populations and linked to secondary stroke mortality.
- Its association with primary events and mortality in type 2 diabetes remains under-investigated.
Purpose of the Study:
- To assess the association between asymptomatic MCA stenosis and mortality in Chinese patients with type 2 diabetes.
Main Methods:
- Transcranial Doppler identified MCA stenosis in 2,197 diabetic patients.
- Cox regression analyzed associations with all-cause and vascular mortality, adjusting for risk factors.
- Anthropometric and biochemical parameters were compared between groups.
Main Results:
- MCA stenosis independently predicted vascular mortality (HRs 2.47-4.47 for 1-2 vessel disease).
- Severity of stenosis correlated with increased vascular mortality risk.
- Adjustments for risk factors refined the association, particularly for 2-vessel disease.
Conclusions:
- Asymptomatic MCA stenosis is an independent predictor of vascular mortality in type 2 diabetics.
- Aggressive management of vascular risk factors warrants further investigation in this cohort.
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