This Article Full Text Full Text (PDF) All Versions of this Article: 40/3/719    most recent STROKEAHA.108.526624v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Waddy, S. P. Articles by Chimowitz, M. Search for Related Content PubMed PubMed Citation Articles by Waddy, S. P. Articles by Chimowitz, M. Related Collections Health policy and outcome research Risk Factors Arterial thrombosis

(Stroke. 2009;40:719.)
© 2009 American Heart Association, Inc.

Original Contributions

Racial Differences in Vascular Risk Factors and Outcomes of Patients With Intracranial Atherosclerotic Arterial Stenosis

Salina P. Waddy, MD; George Cotsonis, MA; Michael J. Lynn, MS; Michael R. Frankel, MD; Seemant Chaturvedi, MD; Janice E. Williams, PhD, MPH Marc Chimowitz, MBChB

From the Department of Neurology (S.P.W., M.R.F., M.C.), Emory University School of Medicine, Atlanta, Ga; the Department of Biostatistics (G.C., M.J.L.), Emory University Rollins School of Public Health, Atlanta, Ga; the Department of Neurology (S.C.), Wayne State University School of Medicine, Detroit, Mich; and LaGrange (J.E.W.), Ga.

Correspondence to Salina Waddy, MD, Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322. E-mail swaddy{at}emory.edu

Background and Purpose— Atherosclerotic intracranial stenosis is an important cause of stroke in blacks, yet there are limited data on vascular risk factors and outcome. We analyzed the vascular risk factors and outcomes of blacks and whites in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial.

Methods— Baseline characteristics and outcomes (ischemic stroke, brain hemorrhage, or vascular death combined and ischemic stroke alone) were compared between blacks (n=174) and whites (n=331) using univariate and multivariate analyses.

Results— Blacks were significantly (P<0.05) more likely than whites to be/have: female, hypertension history, diabetes history, higher LDL, higher total cholesterol, lower triglycerides, unmarried, unemployed, nonprivate insurance, no insurance, stroke as qualifying event, <70% stenosis, symptomatic anterior circulation vessel, no antithrombotic medication before qualifying event, and no family history of myocardial infarction. Blacks more frequently reached an end point of ischemic stroke, brain hemorrhage or vascular death (28% versus 20%; hazard ratio of 1.49, 95% CI 1.03 to 2.17, P=0.03), had a higher 2-year event rate (0.28 versus 0.19), and reached the end point of ischemic stroke alone (25% versus 16% at 2 years; hazard ratio of 1.62, P=0.017). In multivariate analysis, race was associated with ischemic stroke (P=0.0488) but not with the end point ischemic stroke, brain hemorrhage or vascular death (P=0.188).

Conclusions— Blacks with intracranial stenosis are at higher risk of stroke recurrence than whites. This risk warrants additional study of factors contributing to stroke in blacks and highlights the need for aggressive risk factor management in blacks to prevent recurrence.

Key Words: stroke • atherosclerosis • race