Racial differences in the distribution of anterior circulation occlusive disease

Gorelick, Philip B.; Caplan, Louis R.; Hier, Daniel B.; Parker, Sherry L.; Patel, Dushyant V.

doi:10.1212/wnl.34.1.54

Cited by 203 publications

(101 citation statements)

References 32 publications

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“…Despite methodological limitations, these studies have shown a higher proportion of lacunar 6 and intracranial atherosclerotic 10 stroke in blacks and Hispanics and a higher proportion of cardioembolic and extracranial atherosclerotic 7,20,22 stroke in whites. In contrast to some prior studies, 6,7,20,22 we found no significant difference in the proportion of lacunar or extracranial atherosclerotic stroke among the 3 race-ethnic groups, although the proportion of lacunar stroke was somewhat lower in whites compared with blacks and Hispanics. Furthermore, our study, which was population based, demonstrates a greater incidence of extracranial atherosclerotic stroke in blacks than suggested by these previous, more selected series and may refute the argument that the low rates of carotid endarterectomy in blacks are caused by a low incidence of extracranial carotid disease.…”

Section: Discussionmentioning

confidence: 99%

“…The smallest race-ethnic disparities in incidence were seen for cardioembolic and cryptogenic stroke. Prior studies that examined cerebrovascular disease location and the relative proportions of ischemic stroke subtypes among races included non-population-based angiogram, 20,21 carotid Doppler, 22 autopsy, 23 and hospital patient 6 -8,10 series. Despite methodological limitations, these studies have shown a higher proportion of lacunar 6 and intracranial atherosclerotic 10 stroke in blacks and Hispanics and a higher proportion of cardioembolic and extracranial atherosclerotic 7,20,22 stroke in whites.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies that examined cerebrovascular disease location and the relative proportions of ischemic stroke subtypes among races included non-population-based angiogram, 20,21 carotid Doppler, 22 autopsy, 23 and hospital patient 6 -8,10 series. Despite methodological limitations, these studies have shown a higher proportion of lacunar 6 and intracranial atherosclerotic 10 stroke in blacks and Hispanics and a higher proportion of cardioembolic and extracranial atherosclerotic 7,20,22 stroke in whites. In contrast to some prior studies, 6,7,20,22 we found no significant difference in the proportion of lacunar or extracranial atherosclerotic stroke among the 3 race-ethnic groups, although the proportion of lacunar stroke was somewhat lower in whites compared with blacks and Hispanics.…”

Section: Discussionmentioning

confidence: 99%

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Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics

et al. 2005

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Background-Stroke incidence is greater in blacks than in whites; data on Hispanics are limited. Comparing subtype-specific ischemic stroke incidence rates may help to explain race-ethnic differences in stroke risk. The aim of this population-based study was to determine ischemic stroke subtype incidence rates for whites, blacks, and Hispanics living in one community. Methods and Results-A comprehensive stroke surveillance system incorporating multiple overlapping strategies was used to identify all cases of first ischemic stroke occurring between July 1, 1993, and June 30, 1997, in northern Manhattan. Ischemic stroke subtypes were determined according to a modified NINDS scheme, and age-adjusted, race-specific incidence rates calculated. The annual age-adjusted incidence of first ischemic stroke per 100 000 was 88 (95% CI, 75 to 101) in whites, 149 (95% CI, 132 to 165) in Hispanics, and 191 (95% CI, 160 to 221) in blacks. Among blacks compared with whites, the relative rate of intracranial atherosclerotic stroke was 5.85 (95% CI, 1.82 to 18.73); extracranial atherosclerotic stroke, 3.18 (95% CI, 1.42 to 7.13); lacunar stroke, 3.09 (95% CI, 1.86 to 5.11); and cardioembolic stroke, 1.58 (95% CI, 0.99 to 2.52). Among Hispanics compared with whites, the relative rate of intracranial atherosclerotic stroke was 5.00 (95% CI, 1.69 to 14.76); extracranial atherosclerotic stroke, 1.71 (95% CI, 0.80 to 3.63); lacunar stroke, 2.32 (95% CI, 1.48 to 3.63); and cardioembolic stroke, 1.42 (95% CI, 0.97 to 2.09). Conclusions-The high ischemic stroke incidence among blacks and Hispanics compared with whites is due to higher rates of all ischemic stroke subtypes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics

et al. 2005

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“…Gorelick, et al, have recently noted more diffuse and severe intracranial arterial disease among blacks compared to whites, in a study of arteriograms done for cerebral symptoms. 26 The pathophysiology of intracerebral hemorrhage might differ in the younger, more often hypertensive blacks when compared to whites. Our data did not reveal significant racial differences in mortality or other potential risk factors.…”

Section: Discussionmentioning

confidence: 99%

Hypertension as a risk factor for spontaneous intracerebral hemorrhage.

Brott¹,

Thalinger

Hertzberg

1986

Stroke

331

128

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SUMMARY To better define the etiologic importance of hypertension for spontaneous intracerebral hemorrhage, hospital records were studied for all patients sustaining intracerebral hemorrhage during 1982 in the Cincinnati metropolitan area. Hypertension pre-dating the hemorrhage was present in 45% (69 of 154), as determined by history. A more inclusive definition of hypertension, combining those with a positive history with those found to have left ventricular hypertrophy by electrocardiogram or cardiomegaly by chest radiography, applied in 56% (87 of 154). The cases were compared to controls with and without hypertension derived from the NHANESII study of blood pressure (n = 16,204) to determine relative risk. For the presence of hypertension by history, the relative risk of intracerebral hemorrhage was 3.9 (95% confidence interval, 2.7 to 5.7). For the inclusive definition of hypertension, the relative risk was 5.4 (3.7 to 7.9). Relative risk was also determined for hypertension in blacks ( = 4.4), age > 70 ( = 7), prior cerebral infarction ( = 22), and diabetes ( = 3).We conclude that the term "hypertensive hemorrhage" should be used very selectively, particularly in whites, and propose that hypertension be viewed as one of several important risk factors for spontaneous intracerebral hemorrhage. Stroke Vol 17, No 6, 1986 THE TERM HYPERTENSIVE INTRACEREBRAL HEMORRHAGE is firmly imbedded in the medical literature.'" 3 When the characteristic high density lesion is seen in the computed tomographic scan (CT) critical differential diagnosis in the setting of acute stroke is too often truncated. Hypertension is quickly assumed to be causal, if present on the admission exam or if detected by history.We have been impressed at the bedside that an adequate history of hypertension is often lacking in patients with spontaneous intracerebral hemorrhage. When an adequate history for hypertension is established, other disorders of potential etiologic importance may be identified but are seldom given serious consideration. In prior studies of intracerebral hemorrhage, the blood pressure measurements (BP) were often those obtained during the acute event, 4 ' 5 or they were not provided. 6 Potential risk factors such as prior cerebral infarction or diabetes mellitus, were infrequently documented. 7 In 2 large studies of intracerebral hemorrhage in which criteria for the definition of hypertension were carefully specified, the results differed sharply regarding the importance of hypertension in pathogenesis. 89 A prospective epidemiologic study of intracerebral hemorrhage and potential risk factors is impractical. A ten-year study would require follow-up of approximately one million subjects to obtain 100 or more index cases. A longer study would require fewer subFrom the

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“…[43][44][45] Most South Asian stroke studies do not enumerate the stroke classification or type of infarction, perhaps due to limited imaging facilities in South Asian countries. This may also be explained by the limited number of population-based studies because available information is not sufficient to allow an accurate diagnosis to be made.…”

Section: Type Of Strokementioning

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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Racial differences in the distribution of anterior circulation occlusive disease

Cited by 203 publications

References 32 publications

Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics

Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics

Hypertension as a risk factor for spontaneous intracerebral hemorrhage.

Ischemic Stroke in South Asians

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