(Stroke. 1995;26:14-20.)
© 1995 American Heart Association, Inc.
Articles |
Race-Ethnicity and Determinants of Intracranial Atherosclerotic Cerebral Infarction
The Northern Manhattan Stroke Study
Presented in part in abstract form at the 19th Joint Conference on Stroke and Cerebrovascular Disease, San Diego, Calif, February 17-19, 1994.
From the Neurological Institute (R.L.S., D.E.K., Q.G., M.C.Z.), Public Health (Epidemiology) (R.L.S.) and the Sergievsky Center (R.L.S., D.E.K.), Columbia–Presbyterian Medical Center, New York, NY.
Correspondence to Ralph L. Sacco, MD, Neurological Institute, 710 W 168th St, New York, NY 10032.
Background and Purpose The aim of this investigation was to determine the importance of race as a determinant of intracranial atherosclerotic stroke in a community-based stroke sample.
Methods Residents from northern Manhattan over age 39 years hospitalized for acute ischemic stroke (n=438, black 35%, Hispanic 46%, white 19%) were prospectively evaluated. Index ischemic strokes were classified as atherosclerotic (17%), lacunar (30%), cardioembolic (21%), cryptogenic (31%), and other (1%). Atherosclerotic infarcts were subdivided into extracranial (9%) and intracranial (8%) atherosclerosis.
Results The proportion of extracranial atherosclerotic stroke was similar among the three race-ethnic groups, while intracranial atherosclerosis was more frequent in blacks and Hispanics. The unadjusted odds ratio for nonwhites (blacks and Hispanics combined) was 0.8 (confidence interval [CI], 0.4 to 1.8) for extracranial and 7.8 (CI, 1.04 to 57.7) for intracranial atherosclerosis. Patients with intracranial disease were significantly younger and had an increased frequency of hypercholesterolemia and insulin-dependent diabetes compared with those with nonatherosclerotic disease. The odds ratio for the association of nonwhite race-ethnicity and intracranial atherosclerosis was reduced to 5.2 (CI, 0.7 to 40) after controlling for age and to 4.4 (CI, 0.6 to 35) after controlling for age, education, insulin-dependent diabetes, and hypercholesterolemia.
Conclusions The greater prevalence of diabetes and hypercholesterolemia among blacks and Hispanics from northern Manhattan accounted for much of the increased frequency of intracranial atherosclerotic stroke. Further control of these risk factors could reduce the frequency of this stroke subtype and minimize the disparities among different race-ethnic groups.
Key Words: atherosclerosis • epidemiology • racial differences • risk factors
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R. Gupta, H.C. Schumacher, S. Mangla, P.M. Meyers, H. Duong, A.G. Khandji, R.S. Marshall, J.P. Mohr, and J. Pile-Spellman Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis Neurology, December 23, 2003; 61(12): 1729 - 1735. [Abstract] [Full Text] [PDF]
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S. J. Lee, S.-J. Cho, H.-S. Moon, Y.-M. Shon, K. H. Lee, D.-I. Kim, B.-B. Lee, H. S. Byun, S.-H. Han, and C.-S. Chung Combined Extracranial and Intracranial Atherosclerosis in Korean Patients Arch Neurol, November 1, 2003; 60(11): 1561 - 1564. [Abstract] [Full Text] [PDF]
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J. F. Arenillas, J. Alvarez-Sabin, C. A. Molina, P. Chacon, J. Montaner, A. Rovira, B. Ibarra, and M. Quintana C-Reactive Protein Predicts Further Ischemic Events in First-Ever Transient Ischemic Attack or Stroke Patients With Intracranial Large-Artery Occlusive Disease Stroke, October 1, 2003; 34(10): 2463 - 2468. [Abstract] [Full Text] [PDF]
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H. C. Schumacher, K. Tanji, S. Mangla, P. Meyers, J. Pile-Spellman, A. P. Hays, and J.P. Mohr Histopathological Evaluation of Middle Cerebral Artery After Percutaneous Intracranial Transluminal Angioplasty Stroke, September 1, 2003; 34 (9): e170 - e173. [Abstract] [Full Text] [PDF]
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 R. L. Sacco Preventing Stroke Among Blacks: The Challenges Continue JAMA, June 11, 2003; 289(22): 3005 - 3007. [Full Text] [PDF]
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L. S. Babiarz, D. M. Yousem, B. A. Wasserman, C. Wu, W. Bilker, and N. J. Beauchamp Jr. Cavernous Carotid Artery Calcification and White Matter Ischemia AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 872 - 877. [Abstract] [Full Text] [PDF]
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D. C. Suh, S.-H. Lee, K. R. Kim, S. T. Park, S. M. Lim, S. J. Kim, C. G. Choi, and H. K. Lee Pattern of Atherosclerotic Carotid Stenosis in Korean Patients with Stroke: Different Involvement of Intracranial versus Extracranial Vessels AJNR Am. J. Neuroradiol., February 1, 2003; 24(2): 239 - 244. [Abstract] [Full Text] [PDF]
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A. T. Schneider, A. M. Pancioli, J. C. Khoury, E. Rademacher, A. Tuchfarber, R. Miller, D. Woo, B. Kissela, and J. P. Broderick Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke JAMA, January 15, 2003; 289(3): 343 - 346. [Abstract] [Full Text] [PDF]
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J. L. Hunt, R. Fairman, M. E. Mitchell, J. P. Carpenter, M. Golden, T. Khalapyan, M. Wolfe, D. Neschis, R. Milner, B. Scoll, et al. Bone Formation in Carotid Plaques: A Clinicopathological Study Stroke, May 1, 2002; 33(5): 1214 - 1219. [Abstract] [Full Text] [PDF]
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K. S. Wong, H. Li, W. W.M. Lam, Y. L. Chan, and R. Kay Progression of Middle Cerebral Artery Occlusive Disease and Its Relationship With Further Vascular Events After Stroke Stroke, February 1, 2002; 33(2): 532 - 536. [Abstract] [Full Text] [PDF]
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T. Hirai, Y. Korogi, K. Ono, M. Nagano, K. Maruoka, S. Uemura, and M. Takahashi Prospective Evaluation of Suspected Stenoocclusive Disease of the Intracranial Artery: Combined MR Angiography and CT Angiography Compared with Digital Subtraction Angiography AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 93 - 101. [Abstract] [Full Text] [PDF]
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M. S. Elkind, J. Cheng, B. Boden-Albala, T. Rundek, J. Thomas, H. Chen, L. E. Rabbani, R. L. Sacco, and A. G. Thrift Tumor Necrosis Factor Receptor Levels Are Associated With Carotid Atherosclerosis * Editorial Comment Stroke, January 1, 2002; 33(1): 31 - 38. [Abstract] [Full Text] [PDF]
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J. F. Arenillas, C. A. Molina, J. Montaner, S. Abilleira, M. A. Gonzalez-Sanchez;, and J. Alvarez-Sabin Progression and Clinical Recurrence of Symptomatic Middle Cerebral Artery Stenosis: A Long-Term Follow-Up Transcranial Doppler Ultrasound Study Stroke, December 1, 2001; 32(12): 2898 - 2904. [Abstract] [Full Text] [PDF]
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M. I. Chimowitz Angioplasty or Stenting Is Not Appropriate as First-Line Treatment of Intracranial Stenosis Arch Neurol, October 1, 2001; 58(10): 1690 - 1692. [Full Text] [PDF]
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R. L. Sacco, R. T. Benson, D. E. Kargman, B. Boden-Albala, C. Tuck, I-F. Lin, J. F. Cheng, M. C. Paik, S. Shea, and L. Berglund High-Density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly: The Northern Manhattan Stroke Study JAMA, June 6, 2001; 285(21): 2729 - 2735. [Abstract] [Full Text] [PDF]
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M. S. Elkind, J. Cheng, B. Boden-Albala, M. C. Paik, and R. L. Sacco Elevated White Blood Cell Count and Carotid Plaque Thickness : The Northern Manhattan Stroke Study Stroke, April 1, 2001; 32(4): 842 - 849. [Abstract] [Full Text] [PDF]
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K. S. Wong, H. Li, Y. L. Chan, A. Ahuja, W. W.M. Lam, A. Wong, and R. Kay Use of Transcranial Doppler Ultrasound to Predict Outcome in Patients With Intracranial Large-Artery Occlusive Disease Stroke, November 1, 2000; 31(11): 2641 - 2647. [Abstract] [Full Text] [PDF]
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H. L. Lutsep and W. M. Clark Association of intracranial stenosis with cortical symptoms or signs Neurology, September 12, 2000; 55(5): 716 - 718. [Abstract] [Full Text] [PDF]
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V. N. Thijs and G. W. Albers Symptomatic intracranial atherosclerosis: Outcome of patients who fail antithrombotic therapy Neurology, August 22, 2000; 55(4): 490 - 498. [Abstract] [Full Text] [PDF]
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M. S. V. Elkind, I-F. Lin, J. T. Grayston, and R. L. Sacco Chlamydia pneumoniae and the Risk of First Ischemic Stroke : The Northern Manhattan Stroke Study Stroke, July 1, 2000; 31(7): 1521 - 1525. [Abstract] [Full Text] [PDF]
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M. R. Jones, R. D. Horner, L. J. Edwards, J. Hoff, S. B. Armstrong, C. A. Smith-Hammond, D. B. Matchar, and E. Z. Oddone Racial Variation in Initial Stroke Severity Stroke, March 1, 2000; 31(3): 563 - 567. [Abstract] [Full Text] [PDF]
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W. N. Kernan, C. M. Viscoli, L. M. Brass, R. W. Makuch, P. M. Sarrel, R. S. Roberts, M. Gent, P. Rothwell, R. L. Sacco, R.-C. Liu, et al. The Stroke Prognosis Instrument II (SPI-II) : A Clinical Prediction Instrument for Patients With Transient Ischemia and Nondisabling Ischemic Stroke Stroke, February 1, 2000; 31(2): 456 - 462. [Abstract] [Full Text] [PDF]
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D. Woo, J. Gebel, R. Miller, R. Kothari, T. Brott, J. Khoury, S. Salisbury, R. Shukla, A. Pancioli, E. Jauch, et al. Incidence Rates of First-Ever Ischemic Stroke Subtypes Among Blacks : A Population-Based Study Stroke, December 1, 1999; 30(12): 2517 - 2522. [Abstract] [Full Text] [PDF]
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E. R Mohler III, N. Delanty, D. J Rader, and E. C Raps Statins and cerebrovascular disease: plaque attack to prevent brain attack Vascular Medicine, November 1, 1999; 4(4): 269 - 272. [Abstract] [PDF]
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T. H. Wein, M. A. Smith, and L. B. Morgenstern Race/Ethnicity and Location of Stroke Mortality : Implications for Population-Based Studies Stroke, August 1, 1999; 30(8): 1501 - 1505. [Abstract] [Full Text] [PDF]
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C. P. Derdeyn, R. L. Grubb Jr., and W. J. Powers Cerebral hemodynamic impairment: Methods of measurement and association with stroke risk Neurology, July 1, 1999; 53(2): 251 - 251. [Abstract] [Full Text] [PDF]
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L. J. Kappelle, M. Eliasziw, A. J. Fox, B. L. Sharpe, and H. J. M. Barnett Importance of Intracranial Atherosclerotic Disease in Patients With Symptomatic Stenosis of the Internal Carotid Artery Stroke, February 1, 1999; 30(2): 282 - 286. [Abstract] [Full Text] [PDF]
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R. W. Baumgartner, H. P. Mattle, and G. Schroth Assessment of >=50% and <50% Intracranial Stenoses by Transcranial Color-Coded Duplex Sonography Stroke, January 1, 1999; 30(1): 87 - 92. [Abstract] [Full Text] [PDF]
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P. B. Gorelick Cerebrovascular Disease in African Americans Stroke, December 1, 1998; 29(12): 2656 - 2664. [Full Text] [PDF]
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D. T. Lackland, D. L. Bachman, T. D. Carter, D. L. Barker, S. Timms, and H. Kohli The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt : The Anderson and Pee Dee Stroke Study Stroke, October 1, 1998; 29(10): 2061 - 2068. [Abstract] [Full Text] [PDF]
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H. Yonas, M. R. R. Pindzola, C. Yokota, M. Y. Hasegawa, M. K. Minematsu, and M. T. Yamaguchi Effect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases • Response Stroke, August 1, 1998; 29 (8): 1742 - 1744. [Full Text]
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Prognosis of Patients With Symptomatic Vertebral or Basilar Artery Stenosis Stroke, July 1, 1998; 29(7): 1389 - 1392. [Abstract] [Full Text] [PDF]
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H. Mast, J. L.P. Thompson, I-F. Lin, C. Hofmeister, A. Hartmann, P. Marx, J. P. Mohr, and R. L. Sacco Cigarette Smoking as a Determinant of High-Grade Carotid Artery Stenosis in Hispanic, Black, and White Patients With Stroke or Transient Ischemic Attack Stroke, May 1, 1998; 29(5): 908 - 912. [Abstract] [Full Text] [PDF]
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C. P. Derdeyn, K. D. Yundt, T. O. Videen, D. A. Carpenter, R. L. Grubb Jr, and W. J. Powers Increased Oxygen Extraction Fraction Is Associated With Prior Ischemic Events in Patients With Carotid Occlusion Stroke, April 1, 1998; 29(4): 754 - 758. [Abstract] [Full Text] [PDF]
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T. Segura, J. Serena, A. Molins, and A. Davalos Clusters of Microembolic Signals: A New Form of Cerebral Microembolism Presentation in a Patient With Middle Cerebral Artery Stenosis Stroke, March 1, 1998; 29(3): 722 - 724. [Abstract] [Full Text] [PDF]
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R. L. Sacco, R. Gan, B. Boden-Albala, I-F. Lin, D. E. Kargman, W. A. Hauser, S. Shea, and M. C. Paik Leisure-Time Physical Activity and Ischemic Stroke Risk : The Northern Manhattan Stroke Study Stroke, February 1, 1998; 29(2): 380 - 387. [Abstract] [Full Text] [PDF]
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