Cerebrovascular disease among patients from the Indian subcontinent

Moussouttas, Michael; Aguilar, Lázaro; Fuentes, Karina; Anyanwu, B.N.; Manassarians, H.; Papamitsakis, Nikolaos; Shi, Qian; Visintainer, Paul

doi:10.1212/01.wnl.0000233923.63869.8c

Cited by 20 publications

(15 citation statements)

References 9 publications

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“…Hence, not only is diabetes more common among South Asians compared to other ethnic groups 33 but also it is likely that this is a hereditable risk factor in this population. 34 In the current study, Ͼ40% of the South Asian stroke survivors had evidence of diabetes, and …”

Section: Discussionmentioning

confidence: 50%

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Gunarathne

Patel

Kausar

et al. 2009

Stroke

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Background-The pathophysiology of an increased risk of cerebrovascular disease mortality among South Asians (SA) remains unclear. Indices of arterial stiffness and endothelial dysfunction are independent markers of vascular disease, having both prognostic and diagnostic implications. We hypothesized that there are ethnic variations in indices of arterial stiffness and endothelial dysfunction between SA and European Caucasian (EC) stroke patients, which may underline a poorer prognosis in the former, and further investigated promoters of vessel wall abnormalities. Methods-Using a cross-sectional approach, a total of 100 SA stroke survivors were prospectively recruited from the ongoing West Birmingham Stroke Project. Indices of vessel wall characteristics (arterial stiffness and endothelial function [change in reflective index]) were measured noninvasively using the digital volume pulse analysis technique in a temperature-controlled environment, using a direct standardized approach. SA stroke subjects were compared to 60 EC stroke survivors, 60 SA with risk factors, and 73 healthy controls. Results-Among stroke patients, both ethnic groups were comparable for cardiovascular risk profile, except for more diabetes mellitus in SA (Pϭ0.007) subjects and a higher prevalence of atrial fibrillation in EC (Pϭ0.04) subjects. According to the TOAST and Bamford classifications, SA subjects had more small vessel (Pϭ0.04) and lacunar infarctions (Pϭ0.01). SA subjects had higher measurements of arterial stiffness (PϽ0.001) and impaired endothelialdependent vascular function (change in reflective index %; PϽ0.001). On univariate analysis, endothelial function was negatively correlated with fasting plasma glucose (rϭϪ0.4; PϽ0.001) and total cholesterol level (rϭϪ0.2; PϽ0.001).On multivariate analysis, glycemic status was independently associated with impaired endothelial function (Pϭ0.008) and increased arterial stiffness (PϽ0.001) among SA subjects. Conclusion-SA stroke survivors had more small vessel disease-related cerebrovascular events compared to EC subjects.Underlying glycemic status in SA subjects had an adverse impact on the vascular system, leading to abnormal vessel wall characteristics. (Stroke. 2009;40:2298-2306.)

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Section: Discussionmentioning

confidence: 50%

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Gunarathne

Patel

Kausar

et al. 2009

Stroke

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“…Hence, not only is diabetes more common among South Asians compared with other ethnic groups, 77 but it is likely that this is a hereditable risk factor in this population. 78 Diabetes among South Asian patients with stroke explains poorer survival in this group 38 and a greater incidence of CVD outcomes among South Asian patients with hypertension. 65 Although the presence of diabetes calls for more stringent management of blood pressure, the underlying pathophysiology that accelerates the risk of stroke is not clear.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Ischemic Stroke in South Asians

Gunarathne

Patel

Gammon

et al. 2009

Stroke

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Background and Purpose-Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group. Summary of Review-A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural-urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent. Conclusions-This

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“…ICS is the most common vascular lesion in Asians with ischemic stroke 2, 3, 4. The estimated prevalence of middle cerebral artery stenosis among asymptomatic Asian patients ranges from 7.2% to 29.6%, while Asian patients with ischemic stroke have a higher ICS incidence of 33% to 84% 4, 19.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that the correlation of ICS and ischemic stroke is more prominent in Asians; in contrast, extracranial carotid stenosis (ECS) is more prevalent in whites 1, 2, 3. ICS is thought to be the cause of 33% to 84% of ischemic strokes in Asian populations4 and 8% to 10% of strokes in North America 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

Sung

Lee

Tsai

et al. 2015

JAHA

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BackgroundIntracranial stenosis (ICS) is a major determinant of ischemic stroke in Asians. We determined the clinical significance of different risk factors and the role of ICS in Taiwanese patients with varied distributions of cervicocerebral stenosis.Methods and ResultsPresence of extracranial carotid stenosis (ECS, ≥70%) and ICS (>50%) was examined in 13 539 patients using ultrasonography and magnetic resonance angiography, respectively. Seven hundred thirty‐three patients with non‐ECS/ICS (n=372), isolated ICS (n=112), isolated ECS (n=121), or combined ECS/ICS (CEIS, n=128) were selected. Prevalence of ischemic stroke in each group was compared, and risk factors for stenosis were determined. The area under the receiver operating characteristic curve for each risk factor was calculated. Prevalence of ischemic stroke was highest in patients with CEIS (odds ratio 15.86; P<0.001), followed in decreasing order by those with isolated ICS (odds ratio 7.16; P<0.001), isolated ECS (odds ratio 1.77; P=0.011), and non‐ECS/ICS. Multivariate logistic regression analysis revealed that hypertension, coronary artery disease, and smoking were risk factors for isolated ECS; hypertension, diabetes mellitus, coronary artery disease, and smoking were risk factors for isolated ICS; and diabetes mellitus, coronary artery disease, and smoking were risk factors for CEIS. Smoking, diabetes mellitus, and coronary artery disease were the greatest contributors to CEIS, isolated ICS, and isolated ECS, respectively.ConclusionsCEIS was associated with higher odds of ischemic stroke compared with isolated ICS and isolated ECS. Smoking and diabetes mellitus, major determinants of CEIS and isolated ICS, should be targeted in therapeutic strategies to reduce the risk of ischemic stroke.

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Cerebrovascular disease among patients from the Indian subcontinent

Cited by 20 publications

References 9 publications

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Ischemic Stroke in South Asians

Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis

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