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Ischemic heart disease in black South African stroke patients
J Joubert1, C A McLean, C M Reid
1Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia. joubert@hotkey.net.au
Insights
Coronary artery disease (CAD) is more common in Black South African stroke patients than previously thought. This suggests Black stroke patients may have a similar CAD risk to White patients.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Coronary artery disease (CAD) is common in Western stroke patients.
- CAD is considered rare in Black Africans, including stroke patients.
- Prevalence of CAD in Black South African stroke patients is largely undocumented.
Purpose of the Study:
- To determine the prevalence of coronary artery disease (CAD) in Black South African stroke patients.
- To investigate if CAD prevalence in this population differs from general Black populations.
- To compare CAD risk in Black stroke patients to White stroke patients.
Main Methods:
- Utilized 5 observational studies in Black stroke patients.
- Assessed CAD indicators including bedside diagnosis, resting ECG, clinical examination, cardiac ultrasound, radionuclide scintigraphy, and necropsy.
- Evaluated 741 patients for bedside diagnosis and 555 for resting ECG.
Main Results:
- Bedside questioning revealed minimal angina (0.7%) and no reported myocardial infarction (MI).
- Resting ECG showed myocardial ischemia (14.6%) and MI (2.1%).
- Necropsy revealed MI in 17.4% and significant atherosclerotic stenosis in 50% of patients.
Conclusions:
- CAD prevalence in Black African stroke patients is higher than previously reported.
- Black stroke patients exhibit a significant CAD risk, potentially similar to White stroke patients.
- Findings challenge the notion of CAD rarity in Black African populations, especially in stroke patients.
Background And Purpose:
Stroke patients in western countries frequently have coronary artery disease (CAD). In black Africans, CAD has been reported as being rare in both stroke patients and the general population. In this study, an attempt has been made to determine the prevalence of CAD in a black South African stroke population.
Methods:
The prevalence of CAD was determined by indicators identified through a series of 5 observational studies in black patients diagnosed with stroke. CAD indicators included (1) bedside diagnosis in 741 patients; (2) resting ECG in 555 consecutively admitted patients; (3) a combination of clinical examination, cardiac ultrasound, radionuclide scintigraphy, and multigated blood pool studies in 102 consecutively admitted patients; (4) thallium scintigraphy in 60 patients; and (5) necropsy in 23 patients.
Results:
On bedside questioning, only 0.7% complained of previous angina. There was no history given of myocardial infarction (MI), but documentation of this was found in the clinical notes of 0.7% of the patients. In the resting ECG study, evidence of myocardial ischemia was present in 14.6% and MI in 2.1%. In the combined study, cardiac ischemia was documented on ECG in 12.7% of patients and evidence of previous MI in 5.8%. Cardiac scintigraphic studies revealed changes of myocardial ischemia in 31.7% and MI in 13.3% of the 60 patients studied. Four (17.4%) of 23 patients in the necropsy study had histological evidence of previous MI, and 50% of all patients had evidence of >50% atherosclerotic stenosis in 1, 2, or 3 coronary arteries.
Conclusions:
The prevalence of CAD in black African stroke patients is significantly higher than has been documented in the general nonstroke black population as well as in stroke patients. Black stroke patients may have a risk for CAD similar to that of their white counterparts.