(Circulation. 2001;103:e70.)
© 2001 American Heart Association, Inc.
Book Reviews |
Stroke in Blacks: A Guide to Management and Prevention
Stroke in Blacks: A Guide to Management and Prevention
Richard F. Gillum, MD, P.B. Gorelick, MD, E.S. Cooper, MD, eds.
230 pp. Basel, Switzerland: Karger; 1999. $100.00. ISBN 3-8055-6713-8.
This book addresses an area of great concern in medicine. Stroke is not only a leading cause of death, it also contributes significantly to morbidity. Its incidence in blacks is higher than its incidence in nonblacks; thus, it seems appropriate to address any special characteristics, concerns, and knowledge about stroke in this population. Information on primary and secondary prevention would also be welcomed by any physician or medical care provider working in this area. Primary prevention is where the focus should be for the future, although secondary prevention is equally important for those who have had the misfortune to have already suffered such an event. A guide to management should provide useful information for the diagnosis, characterization, and management of patients with stroke. This text is intended to do that, with a special emphasis on the black population.
There are multiple authors for the 20 chapters, each of which is supposed to address a different aspect of stroke. The authors of most chapters are well known and have experience in the areas addressed in their chapters. However, many of the chapters begin the same way, by providing a comparison of the incidence, prevalence, morbidity, mortality, and statistical numbers for stroke between blacks and nonblacks. Thus, the information is redundant. In addition, sometimes there are unavoidable differences in this information, because the authors may have reviewed different literature or databases to extract these statistics. Although the redundant introductory statements at the beginning of many of the chapters are important, of historic value, and would perhaps be useful or essential for readers who are only interested in that particular aspect of stroke, they nonetheless take up a considerable amount of space in this book. The specific information in each chapter consists of multiple literature reviews, most of which merely provide the statistical differences in the incidence or prevalence of stroke in blacks in America, blacks in different regions of the world, and nonblacks. However, these literature reviews provide little information on the management of stroke. Fortunately, most chapters do conclude with short summaries which, when combined, turn out to be the most useful information for a guide for the management and prevention of stroke in blacks.
The comparison of stroke in blacks and nonblacks is certainly of interest. Unfortunately, there are not enough blacks included in most cited studies on stroke to make a definitive statement concerning differences in the characteristics, complications, and/or outcomes in the populations being compared. As long as this information is not available, it will be difficult to determine whether the management of stroke and the outcomes of this management are/should be different in any patient. It is clear that the risk factors and the anatomical lesions seen with stroke are different in black Americans, blacks in different regions of the world, and nonblacks. Thus, this book provides a wealth of important information concerning the risk factors and what seem to be differences in the intracranial and extracranial lesions that lead to stroke in the black and nonblack populations. Information tabulated from the different sources quoted would have been very helpful for the general reader, rather than the slightly different numbers (frequently followed by a nonsignificant or no P value) provided in the various chapters by the different authors. Almost every chapter had an extensive reference list to indicate the source of the information contained in that chapter, but many chapters stated that the lack of adequate information to make definitive statements concerning statistical and other differences strongly indicates the need for properly designed studies that include a sufficient cohort of blacks to provide the needed information.
This book is an exhaustive review of the literature on the information that is available, and anyone interested in this area should include it as a source. Because of the expertise of the investigators who authored the chapters of this book, areas have been pointed out where the information is inadequate and where more research is needed.
In summary, this is a valuable reference that provides a variety of information on stroke in blacks. It will be useful to those who search for information on different aspects of stroke, whether in blacks or in the general population. However, because of the rapidly changing therapeutic techniques and agents and the inadequate amount of definitive data, it is hard for a single source to provide a precise guide to the management and prevention of strokes in blacks. Nonetheless, this is the most compact source of information currently available on this topic, and it does provide useful information on many of the different aspects of stroke in blacks.
I recommend it for all physicians and health care professionals who work in this area.
Otelio S. Randall, MD
Howard University Hospital
Washington, DC.
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