Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis.
Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis.
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DOI：
10.1161/strokeaha.108.526624
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发表时间：
2009-03
期刊：
影响因子：
8.3
通讯作者：
Chimowitz M
中科院分区：
文献类型：
--
作者：
Waddy SP;Cotsonis G;Lynn MJ;Frankel MR;Chaturvedi S;Williams JE;Chimowitz M
动脉粥样硬化性颅内狭窄是黑人中风的重要原因，但关于血管危险因素和预后的数据有限。在华法林与阿司匹林治疗症状性颅内疾病(WASID)试验中，我们分析了黑人和白人的血管危险因素和结果。使用单变量和多变量分析比较黑人(n=174)和白人(n=331)的基线特征和结果(缺血性中风、脑出血或合并血管死亡和单纯缺血性中风)。黑人显著高于白人(P<；0.05)：女性、高血压病史、糖尿病病史、较高的低密度脂蛋白、较高的总胆固醇、较低的甘油三酯、未婚、失业、非私人保险、无保险、中风为限定事件、70%的狭窄、有症状的前循环血管、限定事件发生前未服用抗血栓药物、无心肌梗死家族史。黑人更多地达到缺血性卒中、脑出血或血管死亡的终点(28%比20%；风险比1.49，95%可信区间1.03比2.17，P=0.03)，2年事件发生率更高(0.28比0.19)，以及单独到达缺血性卒中的终点(2年25%比16%；危险比1.62，P=0.017)。多因素分析显示，RACE与缺血性卒中有关(P=0.0488)，与终点缺血性卒中、脑出血或血管死亡无关(P=0.188)。患有颅内狭窄的黑人比白人中风复发的风险更高。这种风险需要对导致黑人中风的因素进行更多的研究，并强调了在黑人中进行积极的风险因素管理以防止复发的必要性。
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. 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. 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). 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.