Stroke Subtypes and Hypertension

Bogousslavsky, Julien; Castillo, Veronica; Kumral, Emre; Henriques, Isabel Lestro; Melle, Guy van

doi:10.1001/archneur.1996.00550030077025

Cited by 36 publications

(16 citation statements)

References 30 publications

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“…Thus, DM is an equally important risk factor for both LVI and SVI, but has a discriminant impact on different vascular pathology: atherosclerosis/microatheroma versus fibrinoid degeneration of small vessels. Our data are consistent with previous studies which showed that DM did not differentiate LVI from SVI in stroke patients in general [11]or hypertensive stroke patients [2]. Other studies have also shown that DM is a risk factor for extracranial disease [12], intracranial disease [13, 14], lacunar infarction [15, 16], but not ICH [17].…”

Section: Discussionsupporting

confidence: 92%

“…Perhaps, the dichotomized effect of serum cholesterol may be apparent only at its extreme level [31, 33]. Finally, the presence of history of ischemic heart disease has been shown to be a discriminant factor favoring proximal (vs. distal) vascular disease [2]. This was not confirmed by our results, which may be attributed to the very low prevalence of coronary heart disease in our study population (6%).…”

Section: Discussioncontrasting

confidence: 58%

“…Other reports [2, 10]have shown that CS is a discriminant factor favoring LVI (vs. SVI) in patients with HT. Considering the differences in stroke subtypes among different ethnic groups, CS may play a discriminant role in various subtypes of stroke [4, 26].…”

Section: Discussionmentioning

confidence: 92%

“…Recently, several studies have emphasized the differences in risk factors between subgroups of stroke: brain infarction (BI) versus intracerebral hemorrhage (ICH) [1, 2]or small vessel infarction (SVI) versus ICH [3]. However, to our knowledge, no studies have yet focused on the differences in risk factors among strokes involving different levels of the cerebral arteries.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Stroke in Different Levels of Cerebral Arterial Disease

Kim

Choi-Kwon²

1999

Eur Neurol

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Background and Purpose: Despite recent studies on risk factors of stroke, it is still unclear whether certain risk factors differently affect different levels of cerebral arteries in stroke patients. We attempted to study risk factors and lifestyle factors in patients with cerebrovascular diseases affecting different levels of the cerebral arteries. Methods: We studied 343 Korean patients (222 men and 121 women) with acute stroke. Strokes were subdivided into large vessel infarction (LVI, n = 156), small vessel infarction (SVI, n = 105), intracerebral hemorrhage (ICH, n = 82) according to modified TOAST criteria. Patients with cardiogenic embolic infarction, undetermined causes, and miscellaneous causes were excluded. Among the patients with LVI and SVI, 104 and 49 underwent angiographic studies, respectively, who were designated as having definite LVI and definite SVI. Definite LVI was further subdivided into proximal LVI when the internal carotid artery (n = 25), vertebral artery (n = 13) or basilar artery (n = 14) were primarily involved, and distal LVI when the middle cerebral artery (n = 35), anterior cerebral artery (n = 7) or posterior cerebral artery (n = 10) were involved. Using a structured interview, we assessed the risk factors and lifestyles: hypertension, diabetes mellitus (DM), cigarette smoking (CS), alcohol consumption, physical activity and exercise, and the amount of consumption of salt, vegetables, fat, fish and fruits. Serum cholesterol, body mass index and total body fat were also measured. Results: Multivariate analysis showed that in men, DM was a discriminant factor favoring brain infarction (BI) over ICH, definite LVI or ICH and proximal LVI over ICH. Decreased fruit intake differentiated distal LVI from definite SVI, and distal LVI from ICH. In women, DM and abdominal obesity differentiated BI from ICH, while DM favored definite LVI over ICH, proximal LVI over ICH and definite SVI over ICH. Multivariate analysis including sex as a separate variate showed that DM was a factor favoring BI over ICH, definite LVI over ICH, proximal LVI over ICH, distal LVI over ICH and definite SVI over ICH. CS was a factor favoring BI over ICH, while heavy CS was a factor discriminating distal LVI from definite SVI. Male sex was a factor favoring definite LVI over ICH and proximal LVI over ICH. A lesser amount of fruit consumption favored definite SVI over distal LVI. Conclusion: Our results demonstrate that DM in all sexes and central obesity in women are factors discriminating BI from ICH. However, these factors as well as others were not found to discriminate the sizes of the vessels involved in the patients with ischemic stroke, except that being male may be a factor favoring proximal large vessel disease over ICH. Genetic factors or other not yet identified risk factors may be responsible for the differences in the subtypes of ischemic stroke among different ethnic populations.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Stroke in Different Levels of Cerebral Arterial Disease

Kim

Choi-Kwon²

1999

Eur Neurol

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“…1,4,5 Data for the UK black population are sparse, and characteristics such as risk factor profiles from one ethnic group may not be representative of another. 3 Studies that have examined cerebrovascular risk factor profiles have focused on comparisons between hemorrhagic and ischemic stroke, 6 categorizing ischemic stroke broadly into lacunar and nonlacunar infarct [7][8][9] or into etiologic subtypes. 10,11 A widely used classification system, the Bamford classification, 12 classifies cerebral infarction according to the vascular territory involved.…”

mentioning

confidence: 99%

Cerebrovascular Risk Factors and Stroke Subtypes

Hajat

Dundas

Stewart

et al. 2001

Stroke

142

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Background and Purpose-The excess risk of stroke seen in the black population has not been explained by differences in age, sex, and social class, although differences in the frequency of cerebrovascular risk factors may be partly responsible. Data on risk factor profiles for the UK black stroke population are sparse. Previous studies have contrasted the association of cerebrovascular risk factors between hemorrhagic and ischemic stroke and between etiologic subtypes of infarct. The relationship of cerebrovascular risk factors to clinical classifications of stroke, however, has been little examined. The aim of this study was to establish the frequency of cerebrovascular risk factors in patients with first-ever strokes in the South London, UK, population and to examine the relationship of these risk factors to both ethnicity and Bamford stroke subtype. Methods-The study included 1254 first-ever stroke patients registered in the South London Community Stroke Register between 1995 and 1998; 995 patients (79.3%) were white, 203 (16.2%) were black, 52 (4.1%) were of other ethnic origin, and 4 (0.3%) were of unknown ethnic origin. Results-In multivariate analysis, increasing age (PϽ0.001) and previous cerebrovascular disease (Pϭ0.007) were independently associated with infarct rather than hemorrhage. Atrial fibrillation was associated with all nonlacunar (Pϭ0.02), total anterior circulation (Pϭ0.007), and partial anterior circulation infarcts (Pϭ0.02) compared with the lacunar group. All other risk factors were similar between infarct subtypes. Risk factors for hemorrhage subtypes were similar in multivariate analysis; increasing age was the only factor associated with primary intracerebral hemorrhage over subarachnoid hemorrhage (PϽ0.001). The black stroke population suffered significantly less atrial fibrillation (Pϭ0.001) and engaged in less alcohol excess (PϽ0.001) and were less likely to have ever smoked (PϽ0.001). Hypertension (PϽ0.001) and diabetes mellitus (PϽ0.001) were more prevalent in the black population. Conclusions-Physiological cerebrovascular risk factors for the UK black population are similar to those of the US black population, but behavioral risk factors differ. Risk factors differ between ethnic groups in the United Kingdom, and future measures for secondary prevention should take this into consideration. Bamford clinical subtypes bear little association with cerebrovascular risk factors. Other classification systems, such as those that classify stroke by etiology, may be more useful in explaining the excess risk of stroke and the scope for its prevention. (Stroke. 2001;32:37-42.)

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