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RISK FACTORS FOR PATIENTS WITH INTRACRANIAL ATHEROSCLEROTIC DISEASE (ICAD): AN AGE-STRATIFIED ANALYSIS
RISK FACTORS FOR PATIENTS WITH INTRACRANIAL ATHEROSCLEROTIC DISEASE (ICAD): AN AGE-STRATIFIED ANALYSIS
Abstract
Background and Aims
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in Asia. Increasing age is thought to relate to ICAD due to increases in vascular risk factors and general atherosclerotic burden, but ICAD is present in a substantial number of younger stroke patients. This study aims to evaluate the difference in risk factors between younger and older patients with symptomatic ICAD.
Methods
In this prospective cohort study, patients presenting with first onset of acute ischemic stroke or transient ischemic attack due to underlying ICAD of at least moderate severity (>50% stenosis) were prospectively recruited. Patients less than 60 years of age were categorised as young. Multivariate logistical regression analysis, adjusted for sex, diabetes mellitus, dyslipidaemia, and smoking status, was performed to identify risk factors independently associated with younger-onset symptomatic ICAD.
Results
A total of 252 ICAD patients were included, where 40.5% (n=102) were below 60 years. Younger ICAD patients had a higher body mass index(BMI), higher estimated glomerular filtration rate(eGFR), and higher triglyceride levels (Table 1). Older ICAD patients had a higher incidence of hypertension, co-morbidity of ischaemic heart disease, and atrial fibrillation. On transcranial doppler evaluation with breath-holding manoeuvre, a larger proportion of younger ICAD patients had an exhausted vasomotor reactivity. In the multivariate analyses, BMI (p-value <0.001), eGFR (p-value <0.001), triglyceride levels (p-value = 0.004), and exhausted vasomotor reactivity (p-value= 0.010) remained independently associated with younger ICAD.
Conclusions
This study shows that younger and older ICAD patients have varying risk factors, highlighting the potential for targeted risk factor management.