Prevalence and Correlates of Intracranial Atherosclerotic Disease Among Community-Dwelling Older Adults of Amerindian Ancestry. The Three Villages Study.

Oscar H Del Brutto, Victor J Del Brutto, Robertino M Mera, Pedro Pérez, Bettsy Y Recalde, Aldo F Costa, José G Romano, Mark J Sedler

Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2020;29(10):105135

PMID: 32912521

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Knowledge on the prevalence and correlates of intracranial atherosclerotic disease (ICAD) is limited. We aimed to assess prevalence, clinical and neuroimaging correlates of ICAD in a cohort of older adults of Amerindian ancestry.

METHODS

The study included 581 community-dwellers aged ≥60 years (mean age 71 ± 8.4 years; 57% women) living in rural Ecuadorian villages. ICAD was identified by means of CT determinations of carotid siphon calcifications (CSC) or MRA findings of significant stenosis of intracranial arteries. Fully-adjusted logistic regression models were fitted with biomarkers of ICAD as the dependent variables.

RESULTS

A total of 205 (35%) of 581 participants had ICAD, including 185 with high calcium content in the carotid siphons and 40 with significant stenosis of at least one intracranial artery (20 subjects had both biomarkers). Increasing age, high fasting blood glucose, >10 enlarged basal ganglia-perivascular spaces and non-lacunar strokes were associated with high calcium content in the carotid siphons. In contrast, male gender, moderate-to-severe white matter hyperintensities, lacunar and non-lacunar strokes were associated with significant stenosis of intracranial arteries. Stroke was more common among subjects with any biomarker of ICAD than in those with no biomarkers (29% versus 9%, p < 0.001). Significant stenosis of intracranial arteries was more often associated with stroke than high calcium content in the carotid siphons, suggesting that CSC are more likely an ICAD biomarker than causally related to stroke.

CONCLUSIONS

ICAD prevalence in Amerindians is high, and is significantly associated with stroke. CSC and significant stenosis of intracranial arteries may represent different phenotypes of ICAD.

Address: School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador. Electronic address: [email protected].; Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA. Electronic address: [email protected].; Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA. Electronic address: [email protected].; Renaissance School of Medicine, Stony Brook University, New York, NY, USA. Electronic address: [email protected].; Community Center, The Atahualpa Project, Atahualpa, Ecuador. Electronic address: [email protected].; Community Center, The Atahualpa Project, Atahualpa, Ecuador. Electronic address: [email protected].; Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA. Electronic address: [email protected].; Renaissance School of Medicine, Stony Brook University, New York, NY, USA. Electronic address: [email protected].

DOI: 10.1016/j.jstrokecerebrovasdis.2020.105135

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MeSH Terms: Age Factors, Aged, Aging, Comorbidity, Ecuador, Female, Health Status, Humans, Independent Living, Indians, South American, Intracranial Arteriosclerosis, Male, Middle Aged, Prevalence, Risk Assessment, Risk Factors, Rural Health, Stroke, Vascular Calcification