This Article Full Text Full Text (PDF) All Versions of this Article: 40/7/2298    most recent STROKEAHA.109.548388v1 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 Google Scholar Articles by Gunarathne, A. Articles by Lip, G. Y.H. PubMed PubMed Citation Articles by Gunarathne, A. Articles by Lip, G. Y.H. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections Epidemiology Endothelium/vascular type/nitric oxide

(Stroke. 2009;40:2298.)
© 2009 American Heart Association, Inc.

Original Contributions

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Pathophysiological Insights From the West Birmingham Stroke Project

Ashan Gunarathne, MRCP; Jeetesh V. Patel, PhD; Shahid Kausar, FRCP; Brian Gammon, PhD; Elizabeth A. Hughes, FRCP Gregory Y.H. Lip, MD

From University Department of Medicine (A.G., G.Y.H.L.), City Hospital, Birmingham, England, UK; Sandwell Medical Research Unit (J.V.P., B.G., E.A.H.), Sandwell General Hospital, West Bromwich, UK.

Correspondence to Professor G.Y.H. Lip, University Department of Medicine, City Hospital, Birmingham, B18 7QH, England, UK. E-mail g.y.h.lip{at}bham.ac.uk

Background— The pathophysiology of an increased risk of cerebrovascular disease mortality among South Asians (SA) remains unclear. Indices of arterial stiffness and endothelial dysfunction are independent markers of vascular disease, having both prognostic and diagnostic implications. We hypothesized that there are ethnic variations in indices of arterial stiffness and endothelial dysfunction between SA and European Caucasian (EC) stroke patients, which may underline a poorer prognosis in the former, and further investigated promoters of vessel wall abnormalities.

Methods— Using a cross-sectional approach, a total of 100 SA stroke survivors were prospectively recruited from the ongoing West Birmingham Stroke Project. Indices of vessel wall characteristics (arterial stiffness and endothelial function [change in reflective index]) were measured noninvasively using the digital volume pulse analysis technique in a temperature-controlled environment, using a direct standardized approach. SA stroke subjects were compared to 60 EC stroke survivors, 60 SA with risk factors, and 73 healthy controls.

Results— Among stroke patients, both ethnic groups were comparable for cardiovascular risk profile, except for more diabetes mellitus in SA (P=0.007) subjects and a higher prevalence of atrial fibrillation in EC (P=0.04) subjects. According to the TOAST and Bamford classifications, SA subjects had more small vessel (P=0.04) and lacunar infarctions (P=0.01). SA subjects had higher measurements of arterial stiffness (P<0.001) and impaired endothelial-dependent vascular function (change in reflective index %; P<0.001). On univariate analysis, endothelial function was negatively correlated with fasting plasma glucose (r=–0.4; P<0.001) and total cholesterol level (r=–0.2; P<0.001). On multivariate analysis, glycemic status was independently associated with impaired endothelial function (P=0.008) and increased arterial stiffness (P<0.001) among SA subjects.

Conclusion— SA stroke survivors had more small vessel disease-related cerebrovascular events compared to EC subjects. Underlying glycemic status in SA subjects had an adverse impact on the vascular system, leading to abnormal vessel wall characteristics.

Key Words: arterial stiffness • endothelial function • glycemic status • South Asian