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Risk factors for cervical atherosclerosis in patients with transient ischemic attack or minor ischemic stroke
H Palomäki1, M Kaste, R Raininko
1Department of Neurology, University of Helsinki, Finland.
Insights
Age, smoking, and high blood pressure significantly increase the risk of cervical atherosclerosis. Light alcohol consumption may offer protection against this condition in patients with stroke or transient ischemic attack.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Cervical atherosclerosis is a significant risk factor for transient ischemic attack (TIA) and minor ischemic stroke.
- Identifying determinants of cervical atherosclerosis is crucial for stroke prevention strategies.
Purpose of the Study:
- To investigate potential factors influencing the presence and severity of atherosclerosis in the cervical arteries.
- To analyze the relationship between various risk factors and cervical artery disease in patients experiencing TIA or minor ischemic stroke.
Main Methods:
- Cross-sectional study of 294 patients (aged up to 60 years) with TIA or minor ischemic stroke.
- Atherosclerosis defined by visible lesions on cervical artery angiograms.
- Severity assessed using scores for plaque thickness, length, and percentage stenosis.
Main Results:
- Atherosclerosis was present in 61.2% of patients.
- Independent determinants for presence included age, triglycerides, smoking history, and arterial hypertension; light alcohol consumption showed an inverse association.
- Age and HDL/total cholesterol ratio negatively correlated with severity; current smoking and female sex predicted percent stenosis and lesion length.
Conclusions:
- Age, cigarette smoking, and arterial hypertension are key contributors to cervical atherosclerosis.
- Lipid/lipoprotein variables show independent associations with atherosclerotic disease.
- Regular light alcohol consumption demonstrated an inverse association with cervical atherosclerosis.
Background And Purpose:
Our purpose was to study potential determinants of the presence and the severity of cervical atherosclerosis in patients with transient ischemic attack or minor ischemic stroke.
Methods:
Two hundred ninety-four patients up to 60 years of age were included in this cross-sectional study. The male to female ratio was 171/123. Atherosclerosis was defined as the presence of any visible atherosclerotic lesion in anteroposterior or left oblique views of cervical arteries in aortic arch angiograms. The severity of atherosclerosis was assessed using three scores, which were computed separately for the total thickness and length of all plaques as well as for the percent stenosis of the vessels.
Results:
Atherosclerosis was present in 180 patients (61.2%). In a multiple stepwise logistic regression analysis, age, serum triglycerides, smoking history for more than 20 years, arterial hypertension (defined as systolic or diastolic blood pressure values at least 150 or 100 mm Hg, respectively, or the use of antihypertensive medication), regular light alcohol consumption (inversely), and body mass index (marginal inverse association) were independent determinants of the presence of atherosclerosis; the respective odds ratios were 1.1/1 y, 1.8/1 mmol/L, 3.3, 2.4, 0.3, and 0.9/1 kg/m2. In multiple linear regression models, age was associated positively and the ratio of high density lipoprotein to total cholesterol was associated negatively with the severity of atherosclerosis regardless of the scoring method, whereas current smoking and female sex were predictors only of the percent stenosis and the length of the lesions. Arterial hypertension showed a significant association only with the length of the lesions.
Conclusions:
Age, cigarette smoking, and arterial hypertension contribute substantially to atherosclerosis in cervical arteries, but this study also confirms the independent associations of lipid or lipoprotein variables with atherosclerotic disease. An independent inverse association of regular light consumption of alcohol with cervical atherosclerosis was also observed.