Original Article DOI 10.3349/ymj.2010.51.3.318 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 51(3): 318-325, 2010 Increasing Frequency and Burden of Cerebral Artery Atherosclerosis in Korean Stroke Patients Young Dae Kim,1 Hye Yeon Choi,1 Hyun Ji Cho,1 Myoung Jin Cha,1 Chung Mo Nam,2 Sang Won Han,1,3 Hyo Suk Nam,1 and Ji Hoe Heo1 Departments of 1Neurology and 2Preventive Medicine, Yonsei University College of Medicine, Seoul; 3Department of Neurology, Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea. 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. Key Words: Cerebrovascular disorders, atherosclerosis, risk factors, epidemiology Received: May 29, 2009 Revised: July 23, 2009 Accepted: August 6, 2009 Corresponding author: Dr. Ji Hoe Heo, Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: 82-2-2228-1605, Fax: 82-2-393-0705 E-mail: jhheo@yuhs.ac ∙The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2010 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION It is known that the predilection sites of cerebral atherosclerosis differ among races. In Asian patients, intracranial (IC) atherosclerosis is most frequently found, while in Caucasian patients, extracranial (EC) atherosclerosis is more common.1-3 Individual risk factors for atherosclerosis may have differential impacts on the location as well as the development of atherosclerosis.2,4-6 In addition, the development of athero- sclerotic risk factors is greatly influenced by lifestyle. Korean and other Asian populations have been undergoing rapid lifestyle changes as they become industrialized and experience economic growth. As a result, recent epidemiologic studies show that Koreans are more obese and hypertensive than in the past, and that both body mass index (BMI) and diabetes mellitus have also increased.7,8 These changes in lifestyle and risk factor profiles may affect the burden of EC and IC atherosclerosis.9 Stroke is one of the leading causes of death in many Asian countries, and the incidence of atherothrombotic diseases has been rapidly increased. For example, the proportion of ischemic stroke in China increased from 30.2% to 61.9% over 10 years.10 Korea also showed a similar pattern of change.11 The incidence of ische- mic heart disease is also increasing and the mortality from acute myocardial infarc- 318 Yonsei Med J http://www.eymj.org Volume 51 Number 3 May 2010