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Open Access Research article

Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis

Ayeesha Kamran Kamal1*, Farzin Majeed2, Omrana Pasha3, Hasan Rehman4, Muhammad Islam5, Iqbal Azam5, Muhammad Saleem Ilyas6, Munawar Hussain7, Kamran Masood7, Bilal Ahmed8, Sumaira Nazir4, Zafar Sajjad9 and Scott E Kasner10

Author Affiliations

1 Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan

2 Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan

3 Associate Professor, Director Masters in Epidemiology and Biostatistics Program, Community Health Sciences, Aga Khan University, Karachi, Pakistan

4 The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan

5 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

6 Dow University of Health Sciences, Karachi, Pakistan

7 Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan

8 Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan

9 Radiology, Aga Khan University, Karachi, Pakistan

10 Division of Stroke and Neurointensive Care, Comprehensive Stroke Center University of Pennsylvania, Philadelphia, Pennsylvania, USA

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BMC Neurology 2014, 14:155  doi:10.1186/s12883-014-0155-6

Published: 15 August 2014

Abstract

Background

Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.

Methods

The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin–Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios.

Results

Of the 200 participants, ICAD was found in 34.5% (n = 69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association.

Conclusion

ICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD.

Study Registration Number

NCT02072876 webcite 2/25/2014

Keywords:
Intracranial atherosclerosis; Stroke; Asymptomatic; Developing countries; Prevention; Sociodemographic risk factors; Epidemiology