Differences in the distribution of stroke subtypes in a UK black stroke population – final results from the South London Ethnicity and Stroke Study

BMC Medicine

Research Article

Lalit Kalra¹  Hugh S. Markus²  Loes C. A. Rutten-Jacobs²  Charles D. A. Wolfe³  Anthony G. Rudd⁴  Giosue Gulli⁵ 

[1] Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, London, UK;Department of Clinical Neurosciences, Stroke Research group, University of Cambridge, Cambridge, UK;Division of Health and Social Care Research, King’s College London, London, UK;Guy’s and St. Thomas’ NHS Foundation Trust, National Institute for Health Research (NIHR) Biomedical Research Centre, London, UK;Division of Health and Social Care Research, King’s College London, London, UK;Stroke Unit, St. Thomas’ Hospital, London, UK;Neurology, Frimley Park Hospital, Surrey, UK;

关键词: Stroke;    Risk factors;    Ethnicity;    Epidemiology;   

DOI  :  10.1186/s12916-016-0618-2

 received in 2016-02-11, accepted in 2016-04-26,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundStroke incidence is increased in Black individuals but the reasons for this are poorly understood. Exploring the differences in aetiological stroke subtypes, and the extent to which they are explained by conventional and novel risk factors, is an important step in elucidating the underlying mechanisms for this increased stroke risk.MethodsBetween 1999 and 2010, 1200 black and 1200 white stroke patients were prospectively recruited from a contiguous geographical area in South London in the UK. The Trial of Org 10172 (TOAST) classification was used to classify stroke subtype. Age- and sex-adjusted comparisons of socio-demographics, traditional vascular risk factors and stroke subtypes were performed between black and white stroke patients and between Black Caribbean and Black African stroke patients using age-, sex-, and social deprivation-adjusted univariable and multivariable logistic regression analyses.ResultsBlack stroke patients were younger than white stroke patients (mean (SD) 65.1 (13.7) vs. 74.8 (13.7) years). There were significant differences in the distribution of stroke subtypes. Small vessel disease stroke was increased in black patients versus white patients (27 % vs. 12 %; OR, 2.74; 95 % CI, 2.19–3.44), whereas large vessel and cardioembolic stroke was less frequent in black patients (OR, 0.59; 95 % CI, 0.45–0.78 and OR, 0.61; 95 % CI, 0.50–0.74, respectively). These associations remained after controlling for traditional vascular risk factors and socio-demographics. Black Caribbean patients appeared to have an intermediate risk factor and stroke subtype profile between that found in Black African and white stroke patients. Cardioembolic stroke was more strongly associated with Black Caribbean ethnicity versus Black African ethnicity (OR, 1.48; 95 % CI, 1.04–2.10), whereas intracranial large vessel disease was less frequent in Black Caribbean patients versus Black African subjects (OR, 0.44; 95 % CI, 0.24–0.83).ConclusionsClear differences exist in stroke subtype distribution between black and white stroke patients, with a marked increase in small vessel stroke. These could not be explained by differences in the assessed traditional risk factors. Possible explanations for these differences might include variations in genetic susceptibility, differing rates of control of vascular risk factors, or as yet undetermined environmental risk factors.

【 授权许可】

CC BY   
© Gulli et al. 2016