Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis

Salina P. Waddy, George Cotsonis, Michael J. Lynn, Michael R. Frankel, Seemant Chaturvedi, Janice E. Williams, Marc Chimowitz

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background and Purpose - Atherosclerotic intracranial stenosis is an important cause of stroke in blacks, yet there are limited data on vascular risk factors and outcome. We analyzed the vascular risk factors and outcomes of blacks and whites in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial. Methods - Baseline characteristics and outcomes (ischemic stroke, brain hemorrhage, or vascular death combined and ischemic stroke alone) were compared between blacks (n=174) and whites (n=331) using univariate and multivariate analyses. Results - Blacks were significantly (P<0.05) more likely than whites to be/have: female, hypertension history, diabetes history, higher LDL, higher total cholesterol, lower triglycerides, unmarried, unemployed, nonprivate insurance, no insurance, stroke as qualifying event, <70% stenosis, symptomatic anterior circulation vessel, no antithrombotic medication before qualifying event, and no family history of myocardial infarction. Blacks more frequently reached an end point of ischemic stroke, brain hemorrhage or vascular death (28% versus 20%; hazard ratio of 1.49, 95% CI 1.03 to 2.17, P=0.03), had a higher 2-year event rate (0.28 versus 0.19), and reached the end point of ischemic stroke alone (25% versus 16% at 2 years; hazard ratio of 1.62, P=0.017). In multivariate analysis, race was associated with ischemic stroke (P=0.0488) but not with the end point ischemic stroke, brain hemorrhage or vascular death (P=0.188). Conclusions - Blacks with intracranial stenosis are at higher risk of stroke recurrence than whites. This risk warrants additional study of factors contributing to stroke in blacks and highlights the need for aggressive risk factor management in blacks to prevent recurrence.

Original languageEnglish (US)
Pages (from-to)719-725
Number of pages7
JournalStroke
Volume40
Issue number3
DOIs
StatePublished - Mar 2009
Externally publishedYes

Fingerprint

Pathologic Constriction
Stroke
Intracranial Hemorrhages
Blood Vessels
Insurance
Multivariate Analysis
vascular factor
Recurrence
Risk Management
Warfarin
Aspirin
Triglycerides
History
Myocardial Infarction
Cholesterol
Hypertension

Keywords

  • Atherosclerosis
  • Race
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. / Waddy, Salina P.; Cotsonis, George; Lynn, Michael J.; Frankel, Michael R.; Chaturvedi, Seemant; Williams, Janice E.; Chimowitz, Marc.

In: Stroke, Vol. 40, No. 3, 03.2009, p. 719-725.

Research output: Contribution to journalArticle

Waddy, Salina P. ; Cotsonis, George ; Lynn, Michael J. ; Frankel, Michael R. ; Chaturvedi, Seemant ; Williams, Janice E. ; Chimowitz, Marc. / Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. In: Stroke. 2009 ; Vol. 40, No. 3. pp. 719-725.
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AU - Cotsonis, George

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AU - Chaturvedi, Seemant

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AB - Background and Purpose - Atherosclerotic intracranial stenosis is an important cause of stroke in blacks, yet there are limited data on vascular risk factors and outcome. We analyzed the vascular risk factors and outcomes of blacks and whites in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial. Methods - Baseline characteristics and outcomes (ischemic stroke, brain hemorrhage, or vascular death combined and ischemic stroke alone) were compared between blacks (n=174) and whites (n=331) using univariate and multivariate analyses. Results - Blacks were significantly (P<0.05) more likely than whites to be/have: female, hypertension history, diabetes history, higher LDL, higher total cholesterol, lower triglycerides, unmarried, unemployed, nonprivate insurance, no insurance, stroke as qualifying event, <70% stenosis, symptomatic anterior circulation vessel, no antithrombotic medication before qualifying event, and no family history of myocardial infarction. Blacks more frequently reached an end point of ischemic stroke, brain hemorrhage or vascular death (28% versus 20%; hazard ratio of 1.49, 95% CI 1.03 to 2.17, P=0.03), had a higher 2-year event rate (0.28 versus 0.19), and reached the end point of ischemic stroke alone (25% versus 16% at 2 years; hazard ratio of 1.62, P=0.017). In multivariate analysis, race was associated with ischemic stroke (P=0.0488) but not with the end point ischemic stroke, brain hemorrhage or vascular death (P=0.188). Conclusions - Blacks with intracranial stenosis are at higher risk of stroke recurrence than whites. This risk warrants additional study of factors contributing to stroke in blacks and highlights the need for aggressive risk factor management in blacks to prevent recurrence.

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