| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2001;32:37.)
© 2001 American Heart Association, Inc.
Original Contributions |
Cerebrovascular Risk Factors and Stroke Subtypes
Differences Between Ethnic Groups
From Public Health Sciences (C.H., R.D., J.A.S., E.L., C.D.A.W.) and Guy’s & St Thomas’s National Health Service Trust (A.G.R., R.H.), London, UK.
Correspondence to Dr Cother Hajat, MRCP, Public Health Sciences, 5th Floor, Capital House, 42 Weston St, London SE1 3QD, UK. E-mail cother.hajat{at}kcl.ac.uk
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 (P<0.001) and previous cerebrovascular disease (P=0.007) were independently associated with infarct rather than hemorrhage. Atrial fibrillation was associated with all nonlacunar (P=0.02), total anterior circulation (P=0.007), and partial anterior circulation infarcts (P=0.02) 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 (P<0.001). The black stroke population suffered significantly less atrial fibrillation (P=0.001) and engaged in less alcohol excess (P<0.001) and were less likely to have ever smoked (P<0.001). Hypertension (P<0.001) and diabetes mellitus (P<0.001) 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.
Key Words: cerebrovascular disorders • ethnic groups • risk factors • stroke classification
This article has been cited by other articles:
 |
|
 |
|
  P. U. Heuschmann, A. P. Grieve, A. M. Toschke, A. G. Rudd, and C. D.A. Wolfe Ethnic Group Disparities in 10-Year Trends in Stroke Incidence and Vascular Risk Factors: The South London Stroke Register (SLSR) Stroke, August 1, 2008; 39(8): 2204 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Reid, D. Dai, G. J. Gubitz, M. K. Kapral, C. Christian, and S. J. Phillips Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital Stroke, April 1, 2008; 39(4): 1090 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. N. Rowan, H. O. Dickinson, S. Stephens, C. Ballard, R. Kalaria, and R. Anne Kenny Homocysteine and post-stroke cognitive decline Age Ageing, May 1, 2007; 36(3): 339 - 343. [Full Text] [PDF]
|
|
|
|
 |
|
 B. W. Yoon, H. J. Bae, K. S. Hong, S. M. Lee, B. J. Park, K. H. Yu, M. K. Han, Y. S. Lee, D. K. Chung, J. M. Park, et al. Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke Neurology, January 9, 2007; 68(2): 146 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Birman-Deych, M. J. Radford, D. S. Nilasena, and B. F. Gage Use and Effectiveness of Warfarin in Medicare Beneficiaries With Atrial Fibrillation Stroke, April 1, 2006; 37(4): 1070 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Feigin, G. J.E. Rinkel, C. M.M. Lawes, A. Algra, D. A. Bennett, J. van Gijn, and C. S. Anderson Risk Factors for Subarachnoid Hemorrhage: An Updated Systematic Review of Epidemiological Studies Stroke, December 1, 2005; 36(12): 2773 - 2780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Jackson and C. Sudlow Are Lacunar Strokes Really Different?: A Systematic Review of Differences in Risk Factor Profiles Between Lacunar and Nonlacunar Infarcts Stroke, April 1, 2005; 36(4): 891 - 901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Sturm, G. A. Donnan, H. M. Dewey, R. A. L. Macdonell, A. K. Gilligan, V. Srikanth, and A. G. Thrift Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study (NEMESIS) Stroke, October 1, 2004; 35(10): 2340 - 2345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Feigin and A. Rodgers Editorial Comment--Ethnic Disparities in Risk Factors for Stroke: What Are the Implications? Stroke, July 1, 2004; 35(7): 1568 - 1569. [Full Text] [PDF]
|
|
|
|
|
|
C. Hajat, K. Tilling, J. A. Stewart, N. Lemic-Stojcevic, and C. D.A. Wolfe Ethnic Differences in Risk Factors for Ischemic Stroke: A European Case-Control Study Stroke, July 1, 2004; 35(7): 1562 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. F. McGruder, A. M. Malarcher, T. L. Antoine, K. J. Greenlund, and J. B. Croft Racial and Ethnic Disparities in Cardiovascular Risk Factors Among Stroke Survivors: United States 1999 to 2001 Stroke, July 1, 2004; 35(7): 1557 - 1561. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ruo, A. M. Capra, N. G. Jensvold, and A. S. Go Racial variation in the prevalence of atrial fibrillation among patients with heart failure: the Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study J. Am. Coll. Cardiol., February 4, 2004; 43(3): 429 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kamath and G.Y.H. Lip Fibrinogen: biochemistry, epidemiology and determinants QJM, October 1, 2003; 96(10): 711 - 729. [Full Text] [PDF]
|
|
|
|
|
|
S. Olindo, P. Cabre, R. Deschamps, C. Chatot-Henry, P. Rene-Corail, P. Fournerie, M. Saint-Vil, F. May, and D. Smadja Acute Stroke in the Very Elderly: Epidemiological Features, Stroke Subtypes, Management, and Outcome in Martinique, French West Indies Stroke, July 1, 2003; 34(7): 1593 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hillen, C. Coshall, K. Tilling, A. G. Rudd, R. McGovern, and C. D.A. Wolfe Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register Stroke, June 1, 2003; 34(6): 1457 - 1463. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C D A Wolfe, A G Rudd, R Howard, C Coshall, J Stewart, E Lawrence, C Hajat, and T Hillen Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register J. Neurol. Neurosurg. Psychiatry, February 1, 2002; 72(2): 211 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Smadja, P. Cabre, F. May, J.-L. Fanon, P. Rene-Corail, C. Riocreux, J.-C. Charpentier, P. Fournerie, M. Saint-Vil, and J. Ketterle ERMANCIA: Epidemiology of Stroke in Martinique, French West Indies: Part I: Methodology, Incidence, and 30-Day Case Fatality Rate Stroke, December 1, 2001; 32(12): 2741 - 2747. [Abstract] [Full Text] [PDF]
|
|