Racial differences in ischemic cerebrovascular disease

To evaluate racial differences in extracranial carotid atherosclerosis and vascular risk factors in patients with symptomatic cerebrovascular disease.

There are conflicting data on racial differences in certain vascular risk factors and prevalence of large-vessel versus small-vessel disease in patients with stroke.

We prospectively studied 211 consecutive patients admitted to our stroke service. There were 71 African-American, 114 Caucasian, 20 Hispanic, and 6 other patients. Extracranial vascular stenosis was assessed with a carotid duplex (CD) scan. Risk factors monitored included race, age, history of hypertension (HTN), diabetes mellitus (DM), prior stroke, hyperlipidemia, smoking, cardiac disease (congestive heart failure, atrial fibrillation), and family history of stroke. Cholesterol and triglyceride blood levels, and computed tomography/magnetic resonance imaging results were obtained in most cases.

Significant differences were found between Caucasians and African-Americans in several variables. Caucasians had more frequent hypertriglyceridemia and a higher rate of cardiac disease. African-Americans had more frequent lacunar infarcts. There was a trend toward decreased risk of CD scan abnormality, and more HTN and prior stroke in African-Americans. There were no differences in the presence of DM, both HTN and DM, abnormal cholesterol (including high- and low-density lipoprotein) values, and smoking history. Except for the difference in lacunar infarction, there were no differences in the type of stroke.

Our data indicate a greater risk of cardiac disease and hypertriglyceridemia in Caucasians with cerebrovascular disease. There was a trend for Caucasians to have more extracranial carotid disease, and a trend for African-Americans to have more hypertension and prior stroke, although the difference did not reach significance. Consistent with prior racial studies, we found African-Americans to have more lacunar strokes than Caucasians.