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Predictors of recurrent stroke in African Americans
S Ruland1, D Richardson, E Hung
1Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, USA. sruland@uic.edu
Insights
Recurrent stroke is common in African Americans, leading to disability. Hypertension is the most significant modifiable risk factor for stroke recurrence in this population.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Stroke incidence and mortality are significantly higher in African Americans compared to white populations.
- Understanding stroke recurrence is crucial for this high-risk demographic.
Purpose of the Study:
- To characterize recurrent stroke patterns in African Americans.
- To identify the predictive value of vascular risk factors for stroke recurrence in this group.
Main Methods:
- The African-American Antiplatelet Stroke Prevention Study followed 1,809 African Americans with recent noncardioembolic ischemic stroke.
- Data collected included recurrent stroke events, subtypes, and resulting disability.
Main Results:
- 10.6% of participants experienced recurrent stroke, often leading to increased disability.
- Elevated systolic blood pressure, pulse pressure, and mean arterial pressure were associated with increased stroke recurrence risk.
- Baseline Glasgow Outcome Score and longitudinal pulse pressure predicted recurrent stroke.
Conclusions:
- Recurrent stroke significantly increases disability, and disability itself is a predictor of further stroke.
- Hypertension emerges as the most critical modifiable risk factor for recurrent stroke in African Americans.
Background:
Stroke incidence and mortality are disproportionately higher among African Americans than among whites.
Objective:
To describe the recurrent stroke characteristics and determine the predictability of known vascular risk factors for stroke recurrence in African Americans.
Methods:
The authors followed 1,809 African Americans in the African-American Antiplatelet Stroke Prevention Study with recent noncardioembolic ischemic stroke for recurrent stroke, recurrent stroke subtype, and disability.
Results:
Of the subjects, 10.6% experienced a recurrent stroke during follow-up. The mean interval between eligibility and recurrent stroke was 325 days (median 287 days, SD = 224 days). Stroke recurrence resulted in an average 1.5-point increase in the National Institute of Health Stroke Scale (p < 0.001) and a 3.5-point decrease in modified Barthel Index (p < 0.001). Of previously nondisabled subjects, 48% became disabled or died after stroke recurrence (p < 0.0001). Longitudinal analysis resulted in a hazard for recurrent stroke for each 10-mm Hg increase in systolic blood pressure of 1.103 (95% CI: 1.031 to 1.179, p = 0.004), pulse pressure 1.123 (95% CI: 1.041 to 1.213, p = 0.003), and mean arterial pressure 1.123 (95% CI: 1.001 to 1.260, p = 0.048). Multivariate analysis revealed increases in the recurrent stroke hazard for increases in baseline Glasgow Outcome Score (1.449, 95% CI: 1.071 to 1.961, p = 0.016) and increases in longitudinal pulse pressure (1.009, 95% CI: 1.001 to 1.017, p = 0.029).
Conclusion:
Recurrent stroke leads to disability and disability predicts recurrent stroke. Hypertension is the most predictive modifiable stroke risk factor.
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