Racial Differences in Small Vessel Disease Measured in MRI of Ischemic Stroke/TIA Patients

White matter hyperintensities (WMH) and cerebral microbleeds (CMB) are manifestations of cerebral small vessel disease (SVD). We investigated the racial differences in SVD among African American (AA) and white patients with stroke/TIA.

Magnetic resonance imaging (MRI) of brain in consecutive patients were assessed in four years as part of a study. Deep and periventricular WMHs (DWMHs and PVWMHs, respectively) were rated visually on axial fluid-attenuated inversion recovery (FLAIR) sequence using the 3-point Fazekas scale and categorized into none/mild (grades 0 and 1) or moderate/severe (grades 2 and 3). Gradient echo imaging was used to categorize CMBs for number, location, and topography. Patient demographics were collected including vascular risk factors, periodontal disease (PD), and index event (TIA, stroke, and stroke subtype). Univariate (t-tests for continuous variables, and X2 test for categorical variables) and multivariable analyses (multiple logistic regression) were conducted to assess the association between race and SVD.

A total of 861 patients, 469 AA and 360 white, were compared for moderate/severe PVWMH, DWMH, and CMB ≥5. White patients were older (67±11 vs. 60±13, p <0.001) and more likely to be male (60% vs. 52%, p = 0.02). AA patients were more likely to be hypertensive (91% vs. 85%, p = 0.006), diabetic (49% vs. 40%, p = 0.009), and have moderately severe gum disease (55% vs. 36%, p <0.001). AA race was associated with PVWMH (Adjusted OR 1.83, 95% 1.32-2.55) adjusted for age, gender, hypertension, diabetes, and PD. AA race was associated with DWMH (Adjusted OR 1.5, 95% 1.08-2.1) adjusted for age, hypertension, diabetes, and PD. AA race was associated with CMB ≥5 (Adjusted OR 3.93, 95% 1.08-14.36) adjusted for age and hypertension.

We report an independent association between AA race and various manifestations of SVD including moderate/severe DWMH, PVWMH, and CMB ≥5 in stroke/TIA patients.