Correlation Of Coronary Artery Disease With Atherosclerosis Of The Intracranial Cerebral Artery And The Extracranial Carotid Artery

Purpose: We studied the relationship of coronary heart disease to atherosclerosis of the intracranial cerebral artery and extracranial carotid artery. Further investigation was performed for determining the factors independently associated with coronary heart disease, intracranial cerebral artery and extracranial carotid artery atherosclerosis in ischemic stroke patients.Methods: A retrospective study, we consecutively collected 1373 ischemic stroke patients in the Third Affiliated Hospital of Hebei Medical University. The baseline data and stroke risk factors were registered for the recruited patients include sex, age, history of hypertension, diabetes mellitus, hyperlipidemia, smoking, previous transient ischemic attack (TIA), previous stroke, fibrillation atrial, coronary artery disease, and peripheral vascular disease. All patients were underwent imagining and vascular examination. The included patients were older than 18. We excluded the patients who:(1) had not undergone MRA or TCD or DSA; (2) could not be judged if got coronary heart disease; (3) could not be found the causes of stroke; (4) had nonatherosclerotic vasculopathy such as dissection or moyamoya disease, and(5) had nonatherosclerotic heart diseases such as congenital heart disease. We evaluated atherosclerosis of the intracranial artery and the extracranial carotid artery using magnetic resonance angiography and/or transcranial doppler ultrasound. We diagnosed coronary heart disease according to past history and ECG. Among the 1373 initially enrolled patients, 367 were ruled out according to the criteria of exclusion. Finally, 1006 patients were included in this study. We compare the prevalence of coronary heart disease between different distribution of cerebral artery disease throughχ2 test. The factors independently associated with cerebral stenosis (≥50%) and coronary heart disease were obtained from the conventional vascular risk factors using the Logistic regression model. Logistic regression analysis was also performed to evaluate a possible relationship between the intracranial stenosis, extracranial stenosis and coronary heart disease.Results: 1006 cases were met the inclusion criteria. Median age 67 years (17 years) (range: 29-95). 616(61.2%) were male, 390(38.8%) were female. The risk profile of the study group included hypertension in 733 (72.9%) patients, diabetes mellitus in 327(32.5%), hyperlipidemia in 488 (48.5%), smoking in 355(35.3%), cerebral arterial stenosis 676(67.2%), intracranial arterial stenosis in 643 (64.9%), extracranial arterial stenosis in 138(13.7%), isolated intracranial arterial stenosis in 505(50.2%), isolated extracranial arterial stenosis in 33 (3.3%), the coexistence of intracranial and extracranial arterial stenosis in 521(51.8%). The prevalence of coronary heart disease was not significantly different between different distribution of cerebral artery disease. Multiple logistic regression analysis showed that: hypertension (OR: 1.686, 95% CI: 1.263-2.251, P<0.001), diabetes mellitus (OR: 1.587, 95% CI: 1.185-2.125, P=0.002), hyperlipidemia (OR: 1.382, 95% CI: 1.058-1.805, P=0.018) were independently associated with intracranial arterial stenosis; age (OR: 1.019, 95% CI: 1.002-1.035, P=0.024), diabetes (OR: 1.686, 95% CI: 1.197-2.375, P=0.003), smoking (OR: 1.511, 1.043-2.188, P=0.029) were associated with extracranial arterial stenosis independently. Hypertension (76.2% vs. 60.6%, P=0.044)and hyperlipidemia (49.9% vs. 24.2%, P=0.004) were higher in the patients with isolated incranial arterial stenosis than in the patients with isolated extracranial arterial stenosis. But patients with extracranial artery stenosis were older than patients with intracranial arterial stenosis (P<0.001). the distribution of Sex (P=0.818), diabetes (P=0.823) and smoking (P=0.761) were not significantly different between the two groups. Univariate Logistic analysis showed that coronary heart disease was not significantly correlated with intracranial arterial stenosis(OR: 1.109, 95%CI: 0.857-1.435, P=0.431) and extracranial artery stenosis(OR: 1.385, 95%CI: 0.993-1.932, P=0.055). After adjusted for age, sex, hypertension, diabetes, hyperlipidemia and smoking history, coronary heart disease was not independent predictor of intracranial arterial stenosis (OR: 0.928, 95%CI: 0.704-1.224, P=0.597) or extracranial arterial stenosis (OR: 1.195, 95%CI: 0.837-1.705, P=0.326). From the logistic regression model, age (OR: 1.053, 95% CI: 1.039-1.066, P<0.001), male (OR: 1.503, 95% CI: 1.125-2.008, P=0.006), hypertension (OR: 1.951, 95% CI: 1.447-2.630, P<0.001), smoking (OR: 1.368, 95% CI: 1.013-1.847, P=0.041) were proved to be the factors that independently associated with coronary heart disease. Univariate analysis showed that intracranial arterial stenosis (OR: 1.109, 95% CI: 0.857-1.435, P=0.431) and extracranial arterial stenosis (OR: 1.385, 95% CI: 0.993-1.932, P=0.055) were not significantly correlated with coronary heart disease. After adjusted for age, sex, hypertension, diabetes, hyperlipidemia and smoking, intracranial arterial stenosis (OR: 0.911, 95% CI: 0.689-1.203, P=0.510) and extracranial arterial stenosis (OR: 1.202, 95% CI: 0.846-1.708, P=0.305) were not independent predictors of coronary heart disease.Conclusion: The intracranial arterial therosclerosis, extracranial arterial atherosclerosis and coronary heart disease share respective risk factors. Extracranial atherosclerotic stenosis has the tendency to predict coronary heart disease.