Pathology of Cerebral Atherosclerosis: Influence of Age, Race, and Gender

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Age, race, and gender are among the logical variables to investigate in determining the natural history of disease. In this connection, the pathological lesions of cerebral atherosclerosis have been particularly difficult to investigate. The limitations of autopsy populations, time-consuming dissections of the intracranial and extracranial arteries, and numerous technical problems associated with specimen preparation, shipment, and storage are among the impediments. Long-term repeated studies and grading systems, and the validation thereof, are also elements adding to the complexity of these studies. In the currently available publications, the most systematic studies, several of which are international in scope and from diverse medical centers, permit some tentative conclusions: (1) There is no reliable evidence of a qualitative difference in the lesions of cerebral atherosclerosis among diverse autopsy populations. (2) Quantitative differences exist in lesion severity among different age groups and races and between males and females. (3) Quantitative differences in intracranial versus extracranial atherosclerosis exist that are related to age and to race (white versus black versus Asian) and gender. (4) The role of hypertension as a factor leading to more severe and more complicated lesions is most obvious in black and Japanese autopsy populations, but its influence is not a simple one to decipher. Complicated lesions refer to stenosis, ectasias and aneurysms, thrombosis, ulceration, and calcification and hemorrhages in plaques. (5) Diet is one obvious variable differing in the populations studied so far. Cigarette smoking is probably an important factor in several populations. The role of alcohol consumption is less clear, but in at least one international study, chronic alcoholism seemed to have little effect on the severity of pathological lesions. More investigation into the role of alcoholism and social alcohol consumption is needed. (Stroke. 1993;24[suppl I]:I-22-I-23.)

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