Cerebral White Matter Hyperintensity in African Americans and European Americans with Type 2 Diabetes
Cerebral White Matter Hyperintensity in African Americans and European Americans with Type 2 Diabetes
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DOI：
10.1016/j.jstrokecerebrovasdis.2012.03.019
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发表时间：
2013-10-01
影响因子：
2.5
通讯作者：
Freedman, Barry I.
中科院分区：
文献类型：
--
作者：
Divers, Jasmin;Hugenschmidt, Christina;Freedman, Barry I.
先前涉及市中心人口的研究发现，非裔美国人（AA）的脑白质高信号（WMH）评分高于欧裔美国人（EA）。这一发现可能归因于非裔美国人中心血管疾病（CVD）危险因素的患病率较高以及获得医疗保健的机会较差。尽管心血管疾病危险因素状况存在种族差异，但非裔美国人的亚临床心血管疾病水平却低得矛盾。我们假设患有糖尿病且能良好获得医疗保健的非裔美国人的WMH水平与欧裔美国人相当或更低。在糖尿病心脏研究（DHS） - 心智项目中招募的46名非裔美国人和156名欧裔美国人2型糖尿病患者中分析了WMH分布的种族差异，并在113名非裔美国人和61名欧裔美国人因临床需要进行脑部磁共振成像的患者样本中进行了重复验证。采用威尔科克森两样本检验和线性模型比较非裔美国人和欧裔美国人中WMH的分布，并检验WMH与种族之间的关联。糖尿病心脏研究 - 心智项目中未经调整的平均WMH评分在非裔美国人中为1.9，在欧裔美国人中为2.3（P = 0.3244）。在那些因临床需要进行磁共振成像的患者中，平均WMH评分在非裔美国人中为2.9，在欧裔美国人中为3.9（P = 0.0503）。对年龄和性别进行调整后，非裔美国人和欧裔美国人之间的WMH评分没有统计学上的显著差异。这些独立的数据集显示非裔美国人和欧裔美国人的WMH评分相当，这表明获得医疗保健的差异和环境暴露可能是先前报道的非裔美国人WMH负担过重的原因。
Previous studies involving inner city populations detected higher cerebral white matter hyperintensity (WMH) scores in African Americans (AAs) compared with European Americans (EAs). This finding might be attributable to the higher prevalence of cardiovascular disease (CVD) risk factors and poorer access to healthcare in AAs. Despite racial differences in CVD risk factor profiles, AAs have paradoxically lower levels of subclinical CVD. We hypothesized that AAs with diabetes and good access to healthcare would have comparable or lower levels of WMH as EAs. Racial differences in the distribution of WMH were analyzed in 46 AAs and 156 EAs with type 2 diabetes enrolled in the Diabetes Heart Study (DHS)-Mind, and replicated in a sample of 113 AAs and 61 EAs patients who had clinically indicated cerebral magnetic resonance imaging. Wilcoxon 2-sample tests and linear models were used to compare the distribution of WMH in AAs and EAs and to test for association between WMH and race. The unadjusted mean WMH score from the Diabetes Heart Study-Mind was 1.9 inAAs and 2.3 in EAs (P = .3244). Among those with clinically indicated magnetic resonance imaging, the mean WMH score was 2.9 in AAs and 3.9 in EAs (P = .0503). Adjustment for age and sex produced no statistically significant differences in WMH score between AAs and EAs. These independent datasets reveal comparable WMH scores in AAs and EAs, suggesting that disparities in access to healthcare and environmental exposures likely underlie the previously reported excess burden of WMH in AAs.