Race and sex differences in the distribution of cerebral atherosclerosis
Race and sex differences in the distribution of cerebral atherosclerosis
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DOI：
10.1161/01.str.27.11.1974
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发表时间：
1996-11-01
期刊：
影响因子：
8.3
通讯作者：
Litt, B
中科院分区：
文献类型：
--
作者：
Wityk, RJ;Lehmann, D;Litt, B
背景和目的本研究的目的是评估种族、性别和其他危险因素对脑血管动脉粥样硬化闭塞病变位置的影响。先前对脑卒中或短暂性脑缺血发作（TIA）患者的血管造影研究表明，颅外动脉粥样硬化在白人中更常见，颅内疾病在黑人中更常见。非侵入性技术，如双超声，经颅多普勒（TCD）和磁共振血管造影（MRA）允许血管评估的患者比传统的血管造影更有代表性的比例。方法回顾性分析在某社区医院连续就诊2年以上的脑卒中或TIA患者。病变定义为血管造影、双工超声或TCD显示50%或以上的动脉粥样硬化性狭窄，或MRA显示中度狭窄。结果白人比黑人更易发生颈动脉颅外病变（33%比15%，P = .001），但颅内病变的患者比例相似（24%比22%）。男性比女性更容易出现颅内病变（29%比14%，P = 0.03）。当使用多变量logistic回归分析时，白人种族是颅外颈动脉病变的唯一预测因子，男性性别是颅内病变的唯一预测因子。卒中/TIA的病因是颅外颈动脉疾病（8%）和颅内疾病（8%）。结论脑动脉粥样硬化的分布受种族和性别的影响，而不受其他血管危险因素的影响。在我们的患者群体中，颅内疾病与颅外颈动脉疾病一样是脑缺血的常见原因。
Background and Purpose The purpose of this study was to assess the influence of race, sex, and other risk factors on the location of atherosclerotic occlusive lesions in cerebral vessels. Previous angiographic studies of patients with stroke or transient ischemic attack (TIA) suggest that extracranial atherosclerosis is more common in whites and intracranial disease is more common in blacks. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD), and magnetic resonance angiography (MRA) allow vascular assessment of a more representative proportion of patients than does conventional angiography alone.Methods Consecutive patients evaluated at a community hospital for stroke or TIA over a 2-year period were reviewed. Lesions were defined as a 50% or greater atherosclerotic stenosis by angiography, duplex ultrasound, or TCD, or a moderate stenosis by MRA.Results Whites were more likely than blacks to have extracranial carotid artery lesions (33% versus 15%, P = .001), but the proportion of patients with intracranial lesions was similar (24% versus 22%). Men were more likely to have intracranial lesions than women (29% versus 14%, P = .03). When multivariate logistic regression analysis was used, white race was the only predictor for extracranial carotid artery lesions, and male sex was the only predictor for intracranial lesions. The cause of stroke/TIA was extracranial carotid artery disease in 8% and intracranial disease in 8% of all patients in the study.Conclusions The distribution of cerebral atherosclerosis is influenced by race and sex but not by other vascular risk factors. In our patient population, intracranial disease is as common a cause of cerebral ischemia as extracranial carotid disease.