This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: November 6, 2007, Volume 116, Number 19 All Versions of this Article: 116/19/2157    most recent CIRCULATIONAHA.107.699785v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Markus, H. S. Articles by Jerrard-Dunne, P. Search for Related Content PubMed PubMed Citation Articles by Markus, H. S. Articles by Jerrard-Dunne, P. Related Collections Acute Stroke Syndromes Cerebral Lacunes Risk Factors for Stroke Epidemiology Related Article

(Circulation. 2007;116:2157-2164.)
© 2007 American Heart Association, Inc.

Stroke

Differences in Stroke Subtypes Between Black and White Patients With Stroke

The South London Ethnicity and Stroke Study

Hugh S. Markus, FRCP; Usman Khan, MRCP; Jonathan Birns, MRCP; Andrew Evans, MRCP; Lalit Kalra, FRCP; Anthony G. Rudd, FRCP; Charles D.A. Wolfe, FRCP; Paula Jerrard-Dunne, MRCP

From the Centre for Clinical Neuroscience, St George’s University of London (H.S.M., U.K., P.J.-D.); Departments of Stroke Medicine and Health and Social Care Research, Kings College London (J.B., A.E., L.K.); and Guy’s and St Thomas’ NHS Foundation Trust (A.G.R., C.D.A.W.), London, UK.

Correspondence to Professor Hugh Markus, Centre for Clinical Neuroscience, St George’s University of London, London, SW17 ORE, UK. E-mail hmarkus{at}sgul.ac.uk

Received February 28, 2007; accepted August 28, 2007.

Background— Determining whether the distribution of stroke subtypes differs between ethnic groups is important in understanding the mechanisms of the increased stroke incidence in black patients.

Methods and Results— In this study, 600 black and 600 white patients with stroke were prospectively and consecutively recruited to determine differences in stroke subtypes. The pathophysiological Trial of Org 10172 (TOAST) classification was used and compared with a clinical (Oxfordshire Community Stroke Project) subtype classification. Stroke subtypes were determined by one investigator by review of original imaging. Black patients with stroke were significantly younger and had higher prevalences of hypertension, diabetes, and obesity. They were less likely to be smokers and had lower prevalences of myocardial infarction and atrial fibrillation. In the black patients, 33% of stroke was due to cerebral small vessel disease compared with 14% in the white stroke cohort (odds ratio, 2.94; 95% confidence interval, 1.97 to 4.39; P<0.001, controlling for age, gender, cardiovascular risk factors, and social class). The black stroke cohort had less large vessel atherosclerosis (odds ratio, 0.49; 95% confidence interval, 0.29 to 0.82; P=0.007) and cardioembolic disease (odds ratio, 0.54; 95% confidence interval, 0.37 to 0.80; P=0.002). Using a classification based on clinical syndrome alone gave a higher estimate of the frequency of small vessel disease stroke, particularly in white patients.

Conclusions— A relative excess of small vessel disease was observed in black patients with stroke compared with an excess of extracranial atherosclerosis and cardioembolic stroke in white patients with stroke that was independent of conventional risk factors and social class. Whether these excesses are due to differences in genetic susceptibility or as-yet undetermined differences in environmental risk remains to be determined.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2007 116: 2095. [Extract] [Full Text]

This article has been cited by other articles:

				S. Banerjee, R. Biram, J. Chataway, and D. Ames South Asian strokes: lessons from the St Mary's stroke database QJM, October 20, 2009; (2009) hcp148v1. [Abstract] [Full Text] [PDF]

				A. Gunarathne, J. V. Patel, S. Kausar, B. Gammon, E. A. Hughes, and G. Y.H. Lip Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians: Pathophysiological Insights From the West Birmingham Stroke Project Stroke, July 1, 2009; 40(7): 2298 - 2306. [Abstract] [Full Text] [PDF]

				R. B. Ramoni, B. E. Himes, M. M. Sale, K. L. Furie, and M. F. Ramoni Predictive Genomics of Cardioembolic Stroke Stroke, March 1, 2009; 40(3_suppl_1): S67 - S70. [Abstract] [Full Text] [PDF]

				P.C. Bennett, S. Silverman, P.S. Gill, and G.Y.H. Lip Ethnicity and peripheral artery disease QJM, January 1, 2009; 102(1): 3 - 16. [Abstract] [Full Text] [PDF]

				U. Khan, C. Crossley, L. Kalra, A. Rudd, C. D.A. Wolfe, P. Collinson, and H. S. Markus Homocysteine and Its Relationship to Stroke Subtypes in a UK Black Population: The South London Ethnicity and Stroke Study Stroke, November 1, 2008; 39(11): 2943 - 2949. [Abstract] [Full Text] [PDF]

				L Kalra, E Iveson, C Rambaran, R Sherwood, P Chowienczyk, J Ritter, A Shah, and T Forrester Homocysteine, migration and early vascular impairment in people of African descent Heart, September 1, 2008; 94(9): 1171 - 1174. [Abstract] [Full Text] [PDF]

				P. A. Wolf and W. B. Kannel Preventing Stroke: Does Race/Ethnicity Matter? Circulation, November 6, 2007; 116(19): 2099 - 2100. [Full Text] [PDF]