Original Paper

Middle Cerebral Artery Stenosis Increased the Risk of Vascular Disease Mortality among Type 2 Diabetic Patients
G. Neil Thomas^a, Xiang-Yan Chen^b, Jian Wen Lin^d, Brian Tomlinson^b, Wynnie W.M. Lam^c, Roxanna Liu^b, Vincent T.F. Yeung^b, Juliana C.N. Chan^b, Ka Sing Wong<sup>b

a</sup>Department of Community Medicine, University of Hong Kong, Pokfulam, Departments of
^bMedicine and Therapeutics and
^cDiagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, and
^dDepartment of Neurology, First Affiliated Hospital, Sun Yat-sen University of Medical Sciences, Guangzhou, PR China

Address of Corresponding Author

Cerebrovasc Dis 2008;25:261-267 (DOI: 10.1159/000116303)

  Key Words

• Blood pressure
• Glucose
• Middle cerebral artery stenosis
• Metabolic syndrome
• Type 2 diabetes mellitus

  Abstract

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.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Dr. Ka Sing Lawrence Wong
Department of Medicine and Therapeutics
Prince of Wales Hospital
Shatin, NT, Hong Kong, SAR (China)
Tel. +852 26 323 144, Fax +852 26 493 761, E-Mail ks-wong@cuhk.edu.hk

  Article Information

Received: March 23, 2007
Accepted: July 19, 2007
Published online: February 13, 2008
Number of Print Pages : 7
Number of Figures : 3, Number of Tables : 1, Number of References : 29