Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study

Jian Gang Duan; Xiang Yan Chen; Alex Lau; Adrian Wong; G Neil Thomas; Brian Tomlinson; Roxanna Liu; Juliana C N Chan; Thomas W Leung; Vincent Mok; Ka Sing Wong

doi:10.1371/journal.pone.0106623

Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study

Jian Gang Duan, Xiang Yan Chen, Alex Lau, Adrian Wong, G Neil Thomas, Brian Tomlinson, Roxanna Liu, Juliana C N Chan, Thomas W Leung, Vincent Mok, Ka Sing Wong

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Abstract

OBJECTIVE: To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes.

METHODS: In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death.

RESULTS: Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03).

CONCLUSIONS: Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.

Original language	English
Article number	e106623
Journal	PLoS ONE
Volume	9
Issue number	9
DOIs	https://doi.org/10.1371/journal.pone.0106623
Publication status	Published - 5 Sept 2014

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Duan, J. G., Chen, X. Y., Lau, A., Wong, A., Thomas, G. N., Tomlinson, B., Liu, R., Chan, J. C. N., Leung, T. W., Mok, V., & Wong, K. S. (2014). Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study. PLoS ONE, 9(9), Article e106623. https://doi.org/10.1371/journal.pone.0106623

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title = "Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study",

abstract = "OBJECTIVE: To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes.METHODS: In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death.RESULTS: Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03).CONCLUSIONS: Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.",

author = "Duan, {Jian Gang} and Chen, {Xiang Yan} and Alex Lau and Adrian Wong and Thomas, {G Neil} and Brian Tomlinson and Roxanna Liu and Chan, {Juliana C N} and Leung, {Thomas W} and Vincent Mok and Wong, {Ka Sing}",

year = "2014",

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day = "5",

doi = "10.1371/journal.pone.0106623",

language = "English",

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T1 - Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis

T2 - a prospective cohort study

AU - Duan, Jian Gang

AU - Chen, Xiang Yan

AU - Lau, Alex

AU - Wong, Adrian

AU - Thomas, G Neil

AU - Tomlinson, Brian

AU - Liu, Roxanna

AU - Chan, Juliana C N

AU - Leung, Thomas W

AU - Mok, Vincent

AU - Wong, Ka Sing

PY - 2014/9/5

Y1 - 2014/9/5

N2 - OBJECTIVE: To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes.METHODS: In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death.RESULTS: Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03).CONCLUSIONS: Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.

AB - OBJECTIVE: To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes.METHODS: In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death.RESULTS: Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all P<0.001). After adjusting for covariates, MCA stenosis was found to be an independent predictor of stroke [hazard ratio (HR) 1.40, 95%CI 1.05-1.86; P = 0.02], ACS (HR 1.35, 95%CI 1.04-1.75; P = 0.02) and cardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03).CONCLUSIONS: Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.

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DO - 10.1371/journal.pone.0106623

M3 - Article

C2 - 25192283

SN - 1932-6203

VL - 9

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e106623

ER -

Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study

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