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Risk factors for stroke in blacks: a critical review
1Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.
Insights
Stroke disproportionately affects Black Americans, with higher mortality rates below age 70. Established risk factors include age, high blood pressure, diabetes, and smoking, but more research is needed to understand racial disparities.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Stroke is a significant cause of death and disability globally, with notably higher mortality rates in Black individuals compared to White individuals under 70 in the US.
- Established risk factors for stroke in Black populations include advanced age, hypertension, diabetes mellitus, and smoking.
Purpose of the Study:
- To identify and assess additional risk factors for stroke in Black populations to improve risk stratification and intervention strategies.
- To investigate the extent to which differences in risk factors explain the observed racial disparities in stroke incidence and mortality.
Main Methods:
- Review of published data on established stroke risk factors in Black populations.
- Analysis of potential contributing factors to higher stroke rates in US Blacks, including hypertension, diabetes, obesity, elevated lipoprotein(a), smoking, and socioeconomic status.
- Discussion of the need for further research into environmental influences and genetic factors.
Main Results:
- Established risk factors (age, hypertension, diabetes, smoking) are confirmed.
- Higher prevalences of hypertension, diabetes, obesity (women), elevated lipoprotein(a) (all), smoking (men), and low socioeconomic status are suggested as contributors to increased stroke risk in Black individuals.
- Significant gaps remain in understanding the role of environmental factors and genetic predispositions.
Conclusions:
- While established risk factors contribute, a comprehensive understanding of stroke disparities in Black populations requires further investigation into environmental exposures and genetic factors.
- Attributing racial differences solely to inborn genetic susceptibility is premature without further research.
Abstract:
Stroke is the third leading cause of death in US Blacks and is an important cause of mortality and morbidity worldwide. Mortality rates are higher in Blacks than in Whites in the United States at ages below 70 years. In Blacks, advanced age, elevated blood pressure, diabetes mellitus, and smoking are the only risk factors for stroke whose status has been firmly established by published data. More data are needed to assess other likely risk factors of importance for risk stratification and intervention and to determine the fraction of racial differences in stroke that may be explained by risk factor differences. Higher prevalences of hypertension, diabetes, obesity (in women), elevated lipoprotein(a) level, smoking (in men), and low socioeconomic status may contribute to the higher stroke incidence and mortality in US Blacks as compared with Whites. However, further environmental influences must be studied and candidate genes identified before assuming that racial differences can be attributed to inborn susceptibility linked to inheritance of specific genes.