Response to Letter by De Silva et al
We are thankful for the helpful comments from De Silva and colleagues with respect to our review on “Ischemic Stroke in South Asians” published in Stroke (2009;40:e415–e423).
In Table 1, with reference to De Silva et al,1 we commented that South Asian patients with stroke had a higher prevalence of hypertension and extracranial disease compared with Chinese patients with stroke. We accept that this was an incorrect comment and clearly not the case. Furthermore, with hindsight, the potential of such ethnic differences would not explain an increased stroke risk in South Asians because data would need to relate to cause preceding effect. Similarly, we were inaccurate to suggest a higher prevalence of lacunar strokes and small artery disease in South Asians given that it has been shown elsewhere that large artery stroke is common among South Asians.2,3,4 Nonetheless, our observation of a higher prevalence of lacunar strokes is confounded by the high prevalence of diabetes in South Asian populations.
The comments by De Silva et al underline the complexity and limitations of characterizing cerebrovascular disease within populations.