Differences in Ischemic and Hemorrhagic Recurrence Rates among Race-Ethnic Groups in the PRoFESS Secondary Stroke Prevention Trial

Estol, Conrado J.; Bath, Philip M.W.; Gorelick, Philip B.; Cotton, Daniel; Martin, Renée; Investigators, PRoFESS

doi:10.1111/ijs.12269

Cited by 18 publications

(19 citation statements)

References 20 publications

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“…The risk of ICH was significantly higher in this group, especially in individuals with hypertension (systolic BP > 150) compared to Caucasians. 30 Similarly, the risk of warfarinrelated ICH was four times higher in Far Eastern patients compared to Caucasians, 31 in patients treated for atrial fibrillation in a large cohort study from California. In an interesting comparison of stroke etiology in long-term residents in Hawaii, similar trends were evident.…”

Section: Discussionmentioning

confidence: 98%

Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry

Akhtar

Salam

Kamran

et al. 2016

European Stroke Journal

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Objective: We analysed the Qatar stroke registry for ethnic variations in patients admitted with cerebrovascular disease at Hamad General Hospital, Qatar. Methods: Patients admitted with acute stroke from January 2014 to December 2015, enrolled in the registry were included in the study. We evaluated the clinical presentation, risk factors, and outcome at discharge and 90 days postdischarge in relation to the patient's ethnic background. Results: A total of 1727 patients were enrolled in the Hamad General Hospital stroke registry (Middle Eastern 594 (34.4%), South East Asian 924 (53.5%) and Far Eastern 209 (12.1%)). There were significant differences in risk factors, clinical presentation and prognosis. Compared to Middle Eastern patients, Far Eastern patients were younger (62.8 AE 13.7 vs. 48.9 AE 9.1 years; p < 0.001). Diabetes and hypertension were significantly more common in Middle Eastern patients (358 (60.3%), 458 (77.1%)) compared to South East Asian patients (420 (45.5%), 596 (64.5%)) and Far Eastern patients (57 (27.3%), 154 (73.7%)), respectively (p < 0.001). Stroke was more severe in the Far Eastern group (median (interquartile range)-5.0 (2-11.5)) compared to the Middle Eastern group (median (interquartile range)-4.0 (1-8)) and South East Asian (median (interquartile range)-4.0 (2-9)), p ¼ 0.011. Mortality at 90 days was highest in patients from the Far East (15/209 (8.2%)) compared to the Middle East (35/594 (6.5%)) and South East Asia (33/924 (4.0)), p ¼ 0.028. Patients from the Far East had significantly higher rates of intracranial hemorrhage compared to the Middle East and South East Asia (70/209 (33.5%), 77/594 (13.0%), and 169/924 (18.3%)), respectively (p < 0.001). Conclusion: The early age at presentation and the poor control of risk factors, especially in patients from South East Asia and the Far East requires attention.

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Section: Discussionmentioning

confidence: 98%

Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry

Akhtar

Salam

Kamran

et al. 2016

European Stroke Journal

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“…In addition to the ethnic differences in the risk of AF, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) investigators found there are ethnic differences in the incidence of stroke. It has been shown that there is a significant difference in myocardial infarction and symptomatic intracerebral haemorrhage recurrence among different ethnic groups [18] , [19] , [20] , [21] . As hypertension and diabetes are highly prevalent among Asian Indian population, it is expected that this significantly contributes to the higher rate of strokes and heart attacks in India [22] .…”

Section: Discussionmentioning

confidence: 99%

Influence of ethnic background on left atrial markers of inflammation, endothelial function and tissue remodelling

Ruediger

John

Kumar

et al. 2018

Indian Pacing and Electrophysiology Journal

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BackgroundIt has been suggested that ethnicity can make a significant difference to the likelihood of thromboembolic stroke related to atrial fibrillation. Ethnic differences have been shown to alter inflammatory and haemostatic factors; however, this may all be confounded by differences in cardiovascular risk factors between different ethnicity. The impact of different ethnicities on the thrombogenic profile is not known. The aim of this study was to investigate differences in markers of inflammation, endothelial function and tissue remodelling between Caucasian and Indian populations with supraventricular tachycardia (SVT).MethodsPatients with structurally normal hearts undergoing catheter ablation for SVT were studied. This study included 23 Australian (Caucasian) patients from the Royal Adelaide Hospital, Adelaide, Australia and 24 Indian (Indian) patients from the Christian Medical College, Vellore, India. Blood samples were collected from the femoral vein, and right and left atria. Blood samples were analysed for the markers of endothelial function (ADMA, ET-1), inflammation (CD40L, VCAM-1, ICAM-1), and tissue remodelling (MMP-9, TIMP-1) using ELISA.ResultsThe study populations were well matched for cardiovascular risk factors and the absence of structural heart disease. No difference in the echocardiographic measurements between the two ethnicities was found. In this context, there was no difference in markers of inflammation, endothelial function or tissue remodelling between the two SVT populations.ConclusionCaucasian and Indian populations demonstrate similar inflammatory, endothelial function or tissue remodelling profiles. This study suggests a lack of an impact of different ethnicity in these populations in terms of thrombogenic risk.

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“…Several more recent meta-analyses showed that, compared with aspirin, cilostazol not only had similar or even slight better therapeutic effects in stroke prevention, but also had a significant reduction in the hemorrhagic stroke [ 18 – 21 , 26 ]. It has been reported that Asians have a higher risk of recurrent ischemic and hemorrhagic stroke in the secondary stroke prevention phase [ 22 ]. Interestingly, a few studies and one recent meta-analysis revealed that cilostazol also provided a protective effect in the secondary prevention of the chronic phase of ischemic stroke in Asian patients [ 16 , 20 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, ABI less than 0.90 was considered as evidence of PAD [ 18 – 20 ]. Absence of PAD was defined as ABI between 0.90 and 1.30 [ 21 , 22 ]. Individuals with ABI greater than 1.30 were excluded, because this indicates poorly compressible leg arteries and inability to gauge arterial perfusion accurately [ 21 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

Role of Cilostazol Therapy in Hemodialysis Patients with Asymptomatic Peripheral Arterial Disease: A Retrospective Cohort Study

Lim

Jeng

et al. 2016

BioMed Research International

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Background. Peripheral arterial disease (PAD) and its relevant complications are more common in hemodialysis (HD) patients, while the evidence regarding antiplatelet therapy in CKD patients is scarce. We retrospectively analyzed the efficacy of cilostazol on outcomes in HD patients with asymptomatic PAD (aPAD). Methods. This cohort study enrolled 217 HD patients (median follow-up time: 5.75 years). Associations between cilostazol use and the outcomes were evaluated by time-dependent Cox regression analysis. Results. During follow-up, 39.5% (47/119) patients used cilostazol for aPAD and 31.8% (69/217) patients died. Cilostazol users had significantly lower CVD and all-cause mortalities (adjusted HR [95% CI]: 0.11 [0.03, 0.51] and 0.2 [0.08, 0.52]) than nonusers. Both death risks were nonsignificantly higher in cilostazol users than in HD patients without aPAD. The unadjusted and adjusted HR [95% CI] of CVD death risk were 0.4 [0.07, 2.12] and 0.14 [0.02, 0.8] for patients with aPAD during follow-up and were 0.74 [0.16, 3.36] and 0.19 [0.04, 0.93] for those with aPAD at initial. Conclusions. In HD patients with aPAD, lower CVD and all-cause mortality rates were observed in low-dose cilostazol user. Further evidences from large-scale prospective study and randomization trial are desired to confirm the effect of cilostazol.

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Differences in Ischemic and Hemorrhagic Recurrence Rates among Race-Ethnic Groups in the PRoFESS Secondary Stroke Prevention Trial

Abstract: We found a significant difference in myocardial infarction and symptomatic intracerebral hemorrhage recurrence among different race-ethnic groups. The risk of recurrent ischemic and hemorrhagic stroke was greater in Asians with high blood pressure.

Cited by 18 publications

References 20 publications

Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry

Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry

Influence of ethnic background on left atrial markers of inflammation, endothelial function and tissue remodelling

Role of Cilostazol Therapy in Hemodialysis Patients with Asymptomatic Peripheral Arterial Disease: A Retrospective Cohort Study

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