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Are clinical differences between black and white stroke patients caused by variations in the atherosclerotic
J Joubert1, L B Lemmer, P A Fourie
1Department of Neurology, Medical University of Southern Africa, Pretoria.
Insights
This study on 304 Black stroke patients reveals distinct patterns of atherosclerosis, with less peripheral vascular disease and ischemic heart disease compared to white patients. These differences impact stroke patient investigation, management, and prognosis.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Atherosclerosis significantly impacts stroke etiology and patient outcomes.
- Understanding ethnic variations in atherosclerotic disease patterns is crucial for tailored medical approaches.
Purpose of the Study:
- To investigate the specific patterns and clinical significance of atherosclerotic involvement in various vascular beds among Black stroke patients.
- To compare these findings with established data from white stroke patient populations.
Main Methods:
- Detailed clinical examinations and diagnostic imaging including computed tomography (CT) and echocardiography were performed on 304 Black stroke patients.
- Electrocardiography (ECG) and gated blood pool studies were utilized.
- Autopsy studies were conducted on 30 patients to assess the degree of arterial stenosis.
Main Results:
- Ischemic lesions constituted 71.2% of strokes in Black patients, similar to white populations.
- Carotid bruits (0.62%), peripheral vascular disease (0.9%), and transient ischemic attacks (1.9%) were found to be uncommon.
- Ischemic heart disease (6.9%) appeared less prevalent than in reported white stroke patients.
- Autopsy revealed a maximum extracranial carotid artery stenosis of 21.7%.
Conclusions:
- Significant differences exist in the site and degree of atherosclerosis in Black versus white stroke patients.
- These ethnic variations in atherosclerosis influence the clinical presentation, investigation, management, and prognosis of stroke.
Abstract:
The differences in site and degree of atherosclerotic involvement of various vascular beds and their clinical significance are emphasised in a study of 304 black stroke patients. Detailed clinical examinations, computed tomography (CT), gated blood pool studies, echocardiography and ECG were performed and autopsy studies carried out. CT of the brain showed that non-haemorrhage, i.e. ischaemic lesions, accounted for 71.2% of strokes, a similar figure to that found in white stroke patients. However, carotid bruits (0.62%) and peripheral vascular disease (0.9%) followed by transient ischaemic attacks (1.9%) were found to be uncommon. Similarly, ischaemic heart disease (6.9%) appeared to be less common than the incidence in reported white stroke patients. In 30 patients who came to autopsy, the maximum degree of atherosclerotic stenosis of the extracranial carotid arteries was 21.7% of the lumen diameter. The differences in the site and degree of atherosclerosis in blacks not only give rise to differences in the clinical features of stroke patients but may have an important bearing on their investigation, management and prognosis.