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Comparing Risk Factor Profiles between Intracerebral Hemorrhage and Ischemic Stroke in Chinese and White Populations:
Chung-Fen Tsai1,2, Niall Anderson3, Brenda Thomas2
1Department of Neurology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
Insights
Chinese populations show distinct stroke risk factors. Hypertension and alcohol consumption are more common in intracerebral hemorrhage (ICH) versus ischemic stroke (IS) among Chinese, unlike white populations. Further research is needed.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Intracerebral hemorrhage (ICH) constitutes a higher proportion of strokes in Chinese populations compared to other ethnicities.
- The underlying reasons for this disparity in stroke type prevalence remain incompletely understood.
Purpose of the Study:
- To compare the frequency of major stroke risk factors between intracerebral hemorrhage (ICH) and ischemic stroke (IS).
- To investigate ethnic differences in these risk factor frequencies between Chinese and white populations of European descent.
Main Methods:
- Systematic review of studies published since 1990 comparing risk factors for ICH versus IS.
- Pooled prevalence and odds ratios (ORs) were calculated for each risk factor in Chinese and white populations separately.
Main Results:
- Analysis included 6 studies (36,190 Chinese) and 7 studies (52,100 white patients).
- Atrial fibrillation (AF) prevalence was lower in Chinese. Pooled ORs for ICH vs. IS were largely similar between ethnic groups.
- In Chinese, younger age, higher hypertension, and alcohol use were linked to ICH vs. IS. In whites, hypercholesterolemia and smoking were less common in ICH vs. IS.
Conclusions:
- Disparities in risk factor distributions suggest variations in underlying stroke mechanisms between Chinese and white populations.
- Further large-scale prospective studies are required to confirm these findings and explore potential confounders.
Background:
Chinese populations have a higher proportion of intracerebral hemorrhage (ICH) in total strokes. However, the reasons are not fully understood.
Methods:
To assess the differences in frequency of major risk factors between ICH and ischemic stroke (IS) in Chinese versus white populations of European descent, we systematically sought studies conducted since 1990 that compared frequency of risk factors between ICH and IS in Chinese or white populations. For each risk factor, in Chinese and Whites separately, we calculated study-specific and random effects pooled prevalence and odds ratios (ORs) for ICH versus IS.
Results:
Six studies among 36,190 Chinese, and seven among 52,100 white stroke patients studied hypertension, diabetes, atrial fibrillation (AF), ischemic heart disease (IHD), hypercholesterolemia, smoking and alcohol. Pooled prevalence of AF was significantly lower in Chinese. Pooled ORs for ICH versus IS were mostly similar in Chinese and Whites. However, in Chinese--but not Whites--mean age was lower (62 versus 69 years), while hypertension and alcohol were significantly more frequent in ICH than IS (ORs 1.38, 95% CI 1.18-1.62, and 1.46, 1.12-1.91). Hypercholesterolemia and smoking were significantly less frequent in ICH in Whites, but not Chinese, while IHD, AF and diabetes were less frequent in ICH in both.
Conclusions:
Different risk factor distributions in ICH and IS raise interesting possibilities about variation in mechanisms underlying the different distributions of pathological types of stroke between Chinese and Whites. Further analyses in large, prospective studies, including adjustment for potential confounders, are needed to consolidate and extend these findings.
