Current smoking is associated with extracranial carotid atherosclerotic stenosis but not with intracranial large artery diseaseReport as inadecuate




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BMC Neurology

, 17:120

Cerebrovascular disease and stroke

Abstract

BackgroundAccumulating evidence has shown that cigarette smoking is an important risk factor for ischemic stroke. However, it is not clear about the potential mechanisms through which cigarette smoking affects stroke risk. In the study, we aimed to investigate the relationship between cigarette smoking and the occurrence of extracranial ECAS and intracranial atherosclerotic stenosis ICAS.

MethodsWe analyzed patients enrolled in the Chinese intracranial atherosclerosis CICAS, which was a prospective, multicenter, hospital-based cohort study. Smoking status was classified into never, former and current smoking. For those patients with current smoking, data on time duration year and extent the number of cigarette smoked per day was recorded and pack year of smoking was calculated. ICAS was evaluated with 3-dimentional time-of-flight MRA and ECAS was evaluated with cervical ultrasonography or contrast-enhanced MRA. Multivariable Logistic regression was performed to identify the association between smoking status and the occurrence of ECAS and ICAS.

ResultsA total of 2656 patients 92.7% of acute ischemic stroke and 208 7.3% of transient ischemic attack were analyzed. The mean age was 61.9 ± 11.2 and 67.8% were male. There were 141 4.9% patients had only ECAS, 1074 37.5% had only ICAS, and 261 9.1% had both ECAS and ICAS. Current smoking was significantly associated with the occurrence of ECAS adjusted OR = 1.47, 95% CI = 1.09–1.99, P < 0.01. In addition, with 1 year of smoking increment, the risk of ECAS increased by 1.1% adjusted OR = 1.011; 95% CI = 1.003–1.019; P = 0.005; with one cigarette smoked per day increment, the risk of ECAS increased by 1.0% adjusted OR = 1.010; 95% CI = 1.001–1.020; P = 0.03; and with one pack year of smoking increment, the risk of ECAS increased by 0.7% adjusted OR = 1.007; 95% CI = 1.002–1.012; P < 0.01. However, no significant association was found between smoking status and the occurrence of ICAS.

ConclusionA dose–response relationship was identified between cigarette smoking and the occurrence of ECAS, but not ICAS. Further studies on molecular mechanisms were warranted.

KeywordsStroke Smoking Extracranial atherosclerotic stenosis Intracranial atherosclerotic stenosis Association AbbreviationsACAAnterior cerebral artery

AISAcute ischemic stroke

BABasilar artery

CICAS studythe Chinese intracranial atherosclerosis CICAS study

COPDChronic obstructive pulmonary disease

CRFCase Report Form

CTComputerized tomography

DBPDiastolic blood pressure

DSADigital subtract angiography

DWIDiffusion-weighted imaging

ECASExtracranial atherosclerotic stenosis

FLAIRFluid-attenuated inversion recovery sequences

GIBGastrointestinal bleeding

HDLHigh density lipoprotein

ICAInternal carotid artery

ICASIntracranial atherosclerotic stenosis

IQRInterquartile range

IRBInstitutional Review Board

LDLLow density lipoprotein

MCAMiddle cerebral artery

MRIMagnetic resonance imaging

mRSmodified Rankin Scale

NIHSSNational Institutes of Health Stroke Scale

PCAPosterior cerebral artery

SBPSystolic blood pressure

SDStandard deviation

TCCholesterol

TGTriglyceride

TIATransient ischemic attack

Electronic supplementary materialThe online version of this article doi:10.1186-s12883-017-0873-7 contains supplementary material, which is available to authorized users.

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Author: Ruijun Ji - Yuesong Pan - Hongyi Yan - Runhua Zhang - Gaifen Liu - Penglian Wang - Yilong Wang - Hao Li - Xingquan Zhao -

Source: https://link.springer.com/







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