Black-White Differences in Ischemic Stroke Risk Factor Burden in Young Adults

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• US Black population experiences higher stroke incidence than US White population.
• Limited research exists on Black-White differences in vascular risk factors for young adult ischemic stroke.
• Vascular risk factors significantly contribute to the population burden of ischemic stroke.

Purpose of the Study:

• To investigate Black-White differences in the contribution of vascular risk factors to ischemic stroke in young adults.
• To determine the population-attributable risk percent (PAR%) of smoking, diabetes, and hypertension stratified by race and sex.

Main Methods:

• Population-based case-control study of early-onset ischemic stroke (ages 15-49) in the Baltimore-Washington DC region (1992-2007).
• In-person interviews for risk factor data collection in cases and controls.
• Analysis of prevalence, odds ratio, and PAR% for smoking, diabetes, and hypertension, stratified by race and sex.

Main Results:

• Hypertension was the strongest contributor to stroke among Black patients (PAR%: 45.8% men, 26.4% women).
• Cigarette smoking was the strongest contributor among White patients (PAR%: 19.7% men, 32.5% women).
• Diabetes showed significant PAR% in Black men (17.2%) and women (13.4%) compared to White women (7.4%).

Conclusions:

• Modifiable vascular risk factors substantially impact ischemic stroke in young adults.
• Hypertension is a primary driver of stroke burden in young Black adults, necessitating targeted interventions.
• Smoking cessation is critical for stroke prevention in young White adults.