Imaging plays a crucial role in studying and understanding cerebral small vessel disease. Several important findings have emerged from recent applications of advanced brain imaging methods. In patients with acute lacunar syndromes, diffusionweighted MRI studies have shown that the diagnostic precision of using clinical features alone or combined with CT scan findings to diagnose small vessel disease as the underlying cause is poor. Followup imaging studies on patients with acute infarcts related to small vessel disease have shown that the infarct may cavitate, merge into white matter disease abnormalities, or become invisible with time. High resolution MRI may demonstrate intracranial atherosclerosis in larger arteries (that may block orifices of penetrating arteries and cause small deep infarcts), but abnormalities in single penetrating arteries cannot as yet be consistently and reliably visualized for use in clinical practice. The epidemiology and risk factors of silent cerebral infarcts have been further delineated. Patterns of new incident silent infarcts appear related to existing white matter disease, suggesting similarities in pathophysiology. Silent deep infarcts causes local cortical atrophy, and can affect connectivity in the brain. Studies on cerebral microbleeds have shown consistent patterns in their effects on prognosis for a large number of outcomes, but the implications of cerebral microbleeds for treatment decisions remain to be established. Cortical microinfarcts represent the latest addition to the spectrum of small vessel disease in the brain, and appears as the most prevalent SVD entity. An important consensus document on neuroimaging standards for small vessel disease has been recently published.
Arteries ; Atrophy ; Brain ; Cerebral Small Vessel Diseases ; Consensus ; Epidemiology ; Follow-Up Studies ; Humans ; Intracranial Arteriosclerosis ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neuroimaging* ; Prognosis ; Risk Factors ; Stroke ; Stroke, Lacunar ; Tomography, X-Ray Computed

Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. Despite the improvement of healthcare system, the mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. Evolution from predominantly rural to urbanized industrial communities result in the increasing prevalence of these risk factors. Similar to other parts of the world, ischemic stroke is the most common stroke type but the proportion of hemorrhagic stroke is higher when compared to Caucasian populations. Among patients with ischemic stroke, lacunar stroke is most common, accounting for almost half followed by atherosclerotic disease. Intracranial atherosclerosis is also prevalent in Thai population. For acute treatment, intravenous thrombolysis has been used in Thailand for over 20 years. Its cost is reimbursed by the national health care system but its use is still limited. With the introduction of the stroke fast track system, prompt stroke treatment across the country is warranted. Stroke unit is now the standard of care in large regional and provincial hospitals.
Adult ; Asian Continental Ancestry Group ; Atrial Fibrillation ; Cause of Death ; Cohort Studies ; Delivery of Health Care ; Dyslipidemias ; Epidemiology* ; Female ; Humans ; Hypertension ; Incidence ; Intracranial Arteriosclerosis ; Male ; Mortality ; Prevalence ; Risk Factors ; Standard of Care ; Stroke* ; Stroke, Lacunar ; Thailand* ; Track and Field

PURPOSE: Koreans have been undergoing rapid lifestyle changes that may have an effect on patterns of cerebral artery atherosclerosis. This study was aimed at determining the frequency and distribution of atherosclerosis in the cerebral arteries and associated temporal changes over the past eight-year period among Korean stroke patients. MATERIALS AND METHODS: By using stroke registry data registered between April 1999 and March 2007, we investigated the presence, severity, and location of cerebral artery atherosclerosis as determined by angiographic findings. Their annual patterns and association with vascular risk factors were investigated. RESULTS: Of 1,955 patients, 1,517 patients (77.6%) demonstrated atherosclerosis in one or more arteries. A significantly increasing trend of atherosclerosis was observed during the past eight years, which was ascribed to an increase of combined extracranial (EC) and intracranial (IC) atherosclerosis. The number of atherosclerotic arteries increased as the number of risk factors increased. In the multivariate analysis, the year and vascular risk factors were independent predictors of the presence of atherosclerosis. CONCLUSION: We found that the atherosclerotic burden has been increasing for the past eight years in Korean stroke patients, particularly the combined EC and IC subtype. Lifestyle changes and increase in vascular risk factors may be contributing factors.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; *Cost of Illness ; Diabetes Mellitus/epidemiology/physiopathology ; Female ; Humans ; Hypertension/epidemiology/physiopathology ; Intracranial Arteriosclerosis/*epidemiology/etiology/pathology ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Young Adult

PURPOSE: Koreans have been undergoing rapid lifestyle changes that may have an effect on patterns of cerebral artery atherosclerosis. This study was aimed at determining the frequency and distribution of atherosclerosis in the cerebral arteries and associated temporal changes over the past eight-year period among Korean stroke patients. MATERIALS AND METHODS: By using stroke registry data registered between April 1999 and March 2007, we investigated the presence, severity, and location of cerebral artery atherosclerosis as determined by angiographic findings. Their annual patterns and association with vascular risk factors were investigated. RESULTS: Of 1,955 patients, 1,517 patients (77.6%) demonstrated atherosclerosis in one or more arteries. A significantly increasing trend of atherosclerosis was observed during the past eight years, which was ascribed to an increase of combined extracranial (EC) and intracranial (IC) atherosclerosis. The number of atherosclerotic arteries increased as the number of risk factors increased. In the multivariate analysis, the year and vascular risk factors were independent predictors of the presence of atherosclerosis. CONCLUSION: We found that the atherosclerotic burden has been increasing for the past eight years in Korean stroke patients, particularly the combined EC and IC subtype. Lifestyle changes and increase in vascular risk factors may be contributing factors.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; *Cost of Illness ; Diabetes Mellitus/epidemiology/physiopathology ; Female ; Humans ; Hypertension/epidemiology/physiopathology ; Intracranial Arteriosclerosis/*epidemiology/etiology/pathology ; Korea/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Young Adult

OBJECTIVETo evaluate the influence of gender on the development and prognosis of atherosclerosis obliterans (ASO).

METHODSEight hundred and forty-two patients with ASO were treated from January 2000 to February 2007. The clinical data were retrospectively collected. And the influence of gender on the development and prognosis of ASO was investigated.

RESULTSAmong the 842 patients, 661 were male and 181 were female. The ratio of male to female was 3.65 : 1.00, and the ratio decreased with increasing age. The mean age of male and female patients were (71.7 +/- 9.0) years and (75.7 +/- 6.8) years, respectively. Significantly more iliac lesions occurred in male patients than in female, while female patients experienced more infrainguinal lesions. The coexistence rate of diabetes and amputation rate were significantly higher in female patients than in male (46.4%/24.7% and 16.0%/9.1%, respectively).

CONCLUSIONThe female patients with ASO appear to have poorer prognosis than the male, despite their lower incidence of ASO.

Adult ; Aged ; Aged, 80 and over ; Arteriosclerosis Obliterans ; epidemiology ; therapy ; Female ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Prognosis ; Sex Factors

Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. The purpose of this study was to evaluate the clinical outcome of urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent CABG. All patients required an urgent surgical revascularization within 24 hr of diagnostic coronary angiography. In-hospital mortality after urgent CABG was 17.3% (18/104). We compared preoperative characteristics and postoperative clinical outcomes between the survival group (n=86) and the mortality group (n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of mortality was low cardiac output. The independent preoperative risk factors of mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492, p=0.034). Other risk factors of mortality included prolonged cardiopulmonary bypass time, prolonged ventilator use, and extended intensive care unit stay. The 10-yr actuarial survival rate was 61%. Although the operative mortality rate was high after urgent CABG, a favorable long-term clinical outcome can be expected if the patients survive.
Treatment Outcome ; Survival Rate ; Survival Analysis ; Risk Factors ; Risk Assessment/*methods ; Outcome Assessment (Health Care) ; Middle Aged ; Male ; Korea/epidemiology ; Incidence ; Humans ; Female ; Critical Care/*statistics & numerical data ; Coronary Artery Bypass/*mortality ; Coronary Arteriosclerosis/*mortality/*surgery ; Aged, 80 and over ; Aged ; Adult

OBJECTIVES: This study was performed to investigate the distribution of apolipoproteins A-I and B among Korean employees and their partners. METHODS: The study population consisted of 7,633 men and women (4,578 men and 3,054 women) residing in Seoul and Kyung-gee Do, with an average age of 43.5+/-8.3 years. Blood samples were collected following at least 12 hours of fasting. Apolipoproteins A-I and B were measured using a Behring Nephelometer analyzer. The body mass index (BMI) for each participant was calculated as weight (kg) divided by height squared (m2). Information on health-related behaviors such as exercise, alcohol intake, and smoking habits was collected through selfadministrated questionnaires. RESULTS: The mean concentrations of Apo A-I were 132.6+/-22.3 mg/dL and 142.9+/-24.8 mg/dL in the men and women, respectively. The concentration of Apo A-I increased significantly across all age categories of men. The mean concentrations of Apo B were 101.7+/-23.2 mg/dL and 87.8+/-23.5 mg/dL in the men and women, respectively, and Apo B increased significantly across all age categories for both the men and women. Exercise and BMI were major determinants for Apo A-I and B levels. The 10th percentile of Apo A-I concentration was 109 mg/dL in the men and 113 mg/dL in the women, and the 90th percentile of Apo B concentration was 131 mg/dL in the men and 118 mg/dL women. CONCLUSIONS: For the prevention of coronary artery disease, we recommend that for individuals in the 10th percentile of concentration for Apo A-I and the 90th percentile of concentration for Apo B, active preventive interventions such as weight loss and exercise should be taken. This study, within its limitations, may be useful for evaluating apolipoprotein A-I and B concentrations in Korean adults.
Spouses ; Smoking ; Questionnaires ; Middle Aged ; Male ; Korea/epidemiology ; Humans ; *Health Behavior ; Female ; Exercise ; Coronary Arteriosclerosis/blood/*prevention & control ; Body Mass Index ; Apolipoproteins B/*blood ; Apolipoprotein A-I/*blood ; Alcohol Drinking ; Adult

OBJECTIVETo explore the reliability and validity of digital pulse wave analyzing method in evaluating arterial compliance in population-based study.

METHODSAll 415 adults (132 men and 283 women) aged 20 to 86 years old were selected from urban (220 persons) and rural (195 persons) areas, respectively by a stratified randomly sampling method. Arterial compliance, evaluated by stiffness index (SI), was measured by using digital pulse wave analyzing method from the Pulse trace machine (Micro medical, London), and the SI value was determined accordingly.

RESULTSIn the study on both repeatability and stability, there was a perfect correlation between the frequent measurements for one individual either on one occasion or on two 40-days-apart occasions. The SI values were not significantly different between the urban and the rural, men and women. Multiple stepwise regressions showed that systolic blood pressure and age were positively correlated with SI value, respectively (both P values were less than 0.001). The correlation kept unchanged after taking account of gender, BMI and heart rate. The mean SI values for people aged 20 to 29, 30 to 39, 40 to 49, 50 to 59 and > or = 60 were 7.35, 8.84, 10.41, 10.95 and 12.01 m/s (P < 0.01), respectively.

CONCLUSIONSBoth systolic blood pressure and age should be contributed as the main influencing factors of arterial compliance. Digital pulse wave analyzing method is a preferable measurement in evaluating arterial compliance in population-based study due to its better repeatability and stability.

Adult ; Aged ; Aged, 80 and over ; Arteries ; physiopathology ; Arteriosclerosis ; epidemiology ; physiopathology ; China ; epidemiology ; Compliance ; Female ; Humans ; Male ; Middle Aged ; Pulse ; methods ; Rural Population ; Sampling Studies ; Urban Population

Small dense LDL (sd-LDL) has recently emerged as an important coronary artery disease (CAD) risk factor. This study was performed to investigate how LDL particle size is related to CAD and acute coronary syndrome (ACS). Blood samples were collected from 504 patients that underwent coronary angiography to evaluate chest pain. The LDL particle size of these samples was measured. The mean LDL particle size was smaller in patients with angiographically proven CAD than in the controls (26.41+/-0.95 vs 26.73+/-0.64nm, p < 0.001), and was negatively correlated with the Framingham risk score (r=-0.121, p=0.007). Patients with more extensive CAD had smaller LDL particles. LDL particle size was also smaller in patients with acute coronary syndrome as compared to non-ACS patients (26.09+/-1.42 vs 26.54+/-0.63nm, p=0.011). These results suggest that sd-LDL is independently associated with the incidence and extent of CAD, and can be a risk factor for the development of ACS in the Korean population.
Risk Factors ; Predictive Value of Tests ; Particle Size ; Middle Aged ; Male ; Lipoproteins, LDL/*blood/chemistry ; Humans ; Female ; Coronary Arteriosclerosis/*blood/*epidemiology ; Biological Markers ; Aged ; Acute Disease

Adult ; Aged ; Arteriosclerosis ; epidemiology ; prevention & control ; Female ; Genotype ; Humans ; Incidence ; Inflammation ; epidemiology ; prevention & control ; Interleukin-10 ; blood ; genetics ; Kidney Failure, Chronic ; complications ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic