Contribution of Racial and Ethnic Differences in Cerebral Small Vessel Disease Subtype and Burden to Risk of Cerebral Hemorrhage Recurrence

Abstract

ObjectiveBlack and Hispanic survivors of intracerebral hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic cerebral small vessel disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.MethodsWe analyzed data from the Massachusetts General Hospital ICH study (n = 593) and the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n = 329). Using CSVD markers derived from MRIs obtained within 90 days of index ICH, we classified ICH cases as cerebral amyloid angiopathy (CAA)–related, hypertensive arteriopathy (HTNA)–related, and mixed etiology. We quantified CSVD burden using validated global, CAA-specific, and HTNA-specific scores. We compared CSVD subtype and severity among White, Black, and Hispanic ICH survivors and investigated its association with ICH recurrence risk.ResultsWe analyzed data for 922 ICH survivors (655 White, 130 Black, 137 Hispanic). Minority ICH survivors had greater global CSVD (p = 0.011) and HTNA burden (p = 0.021) on MRI. Furthermore, minority survivors of HTNA-related and mixed-etiology ICH demonstrated higher HTNA burden, resulting in increased ICH recurrence risk (all p < 0.05).ConclusionsWe uncovered significant differences in CSVD subtypes and severity among White and minority survivors of primary ICH, with direct implication for known disparities in ICH recurrence risk. Future studies of racial/ethnic disparities in ICH outcomes will benefit from including detailed MRI-based assessment of CSVD subtypes and severity and investigating social determinants of health.

Frequency and Phenotype Associations of Rare Variants in 5 Monogenic Cerebral Small Vessel Disease Genes in 200,000 UK Biobank Participants

“… 30 Furthermore, epidemiologic studies have demonstrated racial and ethnic differences in cSVD manifestations and burden, which may have a genetic component. 32 These findings underline the importance of extending future genetic studies to include a broader range of ethnic groups.…”

Cerebral small vessel disease and prognosis in intracerebral haemorrhage: A systematic review and meta‐analysis of cohort studies

“…Furthermore, a manual search was performed and 11 articles were added to the meta‐analysis. Of the 41 finally included studies, most reported the association of CSVD with functional outcome (20/41) [13–15,20–24,27–31,34,36,38–42] and stroke recurrence (17/41) [10,17,18,33,37,40–42,50–58] and only a few involved mortality (5/41) [11,16,22,35,38] and HE (7/41) [12,19,25,29,31,32,39]. It is worth mentioning that nine included studies on CMB and stroke recurrence did not provide information on the relationship between them [50–58], but the authors of a meta‐analysis sought data from their authors to explore this relationship [59].…”

“…WMH was associated with short-term poor functional outcome and mortality after ICH in a recent meta-analysis of nine studies [26]. An increasing number of studies have subsequently provided comprehensive evidence [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. It is plausible that different subtypes of CSVD markers have different effects on the clinical prognosis of patients with ICH.…”

Advances in the Role of Endothelial Cells in Cerebral Small Vessel Disease

“…However, for brevity, we will simply refer to it as CSVD. The aging of the population is closely related to the occurrence of CSVD, but the contribution of ethnicity in CSVD needs to be further confirmed by epidemiological studies ( 7 , 8 ). CSVD increases the risk of acute stroke more than 2-fold ( 9 ), and its classical form is characterized by cognitive impairment or dementia, motor dysfunction, and psychobehavioral abnormalities.…”