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 Table of Contents  
EDITORIAL
Year : 2013  |  Volume : 10  |  Issue : 2  |  Page : 45-46

Intracranial atherosclerotic disease in Nigeria: Any relationship with rising stroke burden in the country?


1 Department of Medicine, University College Hospital, Ibadan; Ministry of Health, Nnamdi Azikiwe Secretariat, Umuahia, Abia State, Nigeria
2 Department of Medicine, University College Hospital, Ibadan, Nigeria

Date of Web Publication13-Feb-2014

Correspondence Address:
Okechukwu S Ogah
Department of Medicine, University College Hospital, PMB 5116, Ibadan, Oyo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-7969.126997

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How to cite this article:
Ogah OS, Falase AO. Intracranial atherosclerotic disease in Nigeria: Any relationship with rising stroke burden in the country?. Nig J Cardiol 2013;10:45-6

How to cite this URL:
Ogah OS, Falase AO. Intracranial atherosclerotic disease in Nigeria: Any relationship with rising stroke burden in the country?. Nig J Cardiol [serial online] 2013 [cited 2019 May 19];10:45-6. Available from: http://www.nigjcardiol.org/text.asp?2013/10/2/45/126997

Intracranial atherosclerosis of the major vessels (intracranial internal carotid artery, middle cerebral artery, vertebral artery, and basilar artery) is the most common pathologic mechanism of ischemic stroke all over the world. [1]

Intracranial atherosclerotic disease (ICAD) is defined as atherosclerosis of the large vessels at the base of the brain. ICAD is commoner in South Asians, Far East Asians, Hispanics, and African Americans, compared to Whites. [1] It accounts for 30-50% and 8-10% of the ischemic strokes in Asians and Caucasians of North America, respectively. [2]

It is now known that 20-45% of non-Caucasians with large artery disease have combined intracranial and extracranial lesions. [2]

In terms of epidemiology, the prevalence of ICAD is 20-54% in adult South Asians, 7% in East Asians, 1-24% in US Whites, 6-22% in US Blacks, and 11% in Hispanics in the USA. [1],[2],[3],[4] ICAD also occurs in 33-50% of Chinese, 26.4-56.3% of Koreans, 47.9% of Singaporeans, and 47% of Thai people. [1]

It is suggested that polymorphic expression of stroke suppressor genes may explain the racial variability to ICAD. [5],[6]

Data from the Warfarin versus Aspirin in Symptomatic Intracranial Disease (WASID) study showed that Blacks with ICAD were more likely to have hypertension, diabetes mellitus, high low-density lipoprotein (LDL), and elevated total cholesterol. [7] Studies have also shown that compared to extracranial atherosclerosis, ICAD is not associated with typical risk factors for coronary artery disease (CAD) or peripheral artery disease, such as male gender and hypercholesterolemia. [8],[9] Metabolic syndrome, but not the individual components, is also associated with ICAD. [10],[11],[12]

In this issue of NJC, Oladapo et al., [13] in a pilot autopsy study at Ibadan, have ignited interest on ICAD in Nigerians. The last attempt to define this condition in Nigerians in the same hospital was about four decades ago by William et al. [14],[15] In the latter study, it was found that 13% of subjects had ICAD, which was commoner in those with cardiovascular (CV) risk factors such as hypertension and diabetes mellitus.

Therefore, the present study is timely, especially because of the fact that stroke and stroke-related complications have become a major cause of morbidity and mortality in the country. [16],[17],[18],[19],[20],[21] The authors documented a prevalence of 45% as against 13% reported by Williams in the late 60s or 70s. Their subjects had various degrees of ICAD (51.1% mild, 28.2% moderate, and 20.7% severe lesions). Over 70% had at least one risk factor for atherosclerosis such as age, increased waist circumference, and abdominal wall thickness.

The high rate of ICAD reported in this pilot study is worrisome, but may also explain the rising burden of stroke in the country.

As this is a pilot study, a larger and more detailed study, preferably a multicenter one, is needed to confirm this finding.

 
  References Top

1.Wong LK. Global burden of intracranial atherosclerosis. Int JStroke 2006;1:158-9.  Back to cited text no. 1
    
2.Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet 2013.  Back to cited text no. 2
    
3.Wong KS, Huang YN, Yang HB, Gao S, Li H, Liu JY, et al. A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology 2007;68:2031-4.  Back to cited text no. 3
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4.Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology 2007;68:2035-8.  Back to cited text no. 4
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5.Cheng-Ching E, Fong J, Ontaneda D, Hussain MS, Katzan I, Gupta R. Intracranial atherosclerosis as a risk factor for ischemic stroke during open heart surgery. J Stroke Cerebrovasc Dis 2010;19:257-60.  Back to cited text no. 5
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6.Mak W, Cheng TS, Chan KH, Cheung RT, Ho SL. A possible explanation for the racial difference in distribution of large-arterial cerebrovascular disease: Ancestral European settlers evolved genetic resistance to atherosclerosis, but confined to the intracranial arteries. Med Hypotheses 2005;65:637-48.  Back to cited text no. 6
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7.Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005;352:1305-16.  Back to cited text no. 7
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8.Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14-20.  Back to cited text no. 8
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9.Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: A review. Stroke 1986;17:648-55.  Back to cited text no. 9
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10.Bang OY, Kim JW, Lee JH, Lee MA, Lee PH, Joo IS, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology 2005;65:296-8.  Back to cited text no. 10
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11.Bang OY, Lee MA, Lee JH, Kim JW, Lee PH, Joo IS, et al. Association of Metabolic Syndrome and C-reactive Protein Levels with Intracranial Atherosclerotic Stroke. J Clin Neurol 2005;1:69-75.  Back to cited text no. 11
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12.Ovbiagele B. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology 2006;66:459.  Back to cited text no. 12
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13.Oladapo OO, Olusakin J, Ogun GO, Akang E. Atherosclerosis of the intracranial carotid arteries in Nigerians: A pilot autopsy study. Niger J Cardiol 2013;10:62-7.  Back to cited text no. 13
    
14.Williams AO, Resch JA. Cerebral atherosclerosis: A comparative study between an African and a Minnesota autopsy population. Neurology;18:287.   Back to cited text no. 14
    
15.Williams AO, Loewenson RB, Lippert DM, Resch JA. Cerebral atherosclerosis and its relationship to selected diseases in Nigerians: A pathological study. Stroke 1975;6:395-401.   Back to cited text no. 15
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16.Owolabi MO, Agunloye AM. Which risk factors are more associated with ischemic rather than hemorrhagic stroke in black Africans? Clin Neurol Neurosurg 2013;115:2069-74.   Back to cited text no. 16
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17.Wahab KW. The burden of stroke in Nigeria. Inter JStroke2008;3:290-2.  Back to cited text no. 17
    
18.Ogun SA, Ojini FI, Ogungbo B, Kolapo KO, Danesi MA. Stroke in south west Nigeria: A 10-year review. Stroke 2005;36:1120-2.  Back to cited text no. 18
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19.Owolabi MO. Taming the burgeoning stroke epidemic in Africa: Stroke quadrangle to the rescue. West Indian Med J 2011;60:412-21.  Back to cited text no. 19
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20.Osuntokun BO. Stroke in the Africans. Afr JMed Med Sci 1977;6:39-53.   Back to cited text no. 20
    
21.Osuntokun BO, Bademosi O, Akinkugbe OO, Oyediran AB, Carlisle R. Incidence of stroke in an African City: Results from the Stroke Registry at Ibadan, Nigeria, 1973-1975. Stroke1979;10:205-7.  Back to cited text no. 21
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