Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

Agyemang, Charles; Oeffelen, A A M van; Nørredam, Marie; Kappelle, L. Jaap; Klijn, Catharina J.M.; Bots, Michiel L.; Stronks, Karien; Vaartjes, Ilonca

doi:10.1161/strokeaha.114.006462

Cited by 53 publications

(31 citation statements)

References 33 publications

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“…The Dutch were chosen as a reference because they are the majority ethnic group in the Netherlands, and most non-Dutch minority groups are known to display a higher risk of CVD than the Dutch. 25,26 The results of logistic regressions are reported as odds ratios (ORs) with 95% CIs. In the regression analysis, we first used a univariate model with only family history as an independent variable (model 1), then adjusted the analysis for age and sex (model 2), and additionally adjusted for smoking status and educational level (model 3).…”

Section: Discussionmentioning

confidence: 99%

“…Second, we analyzed the relationship separately for each ethnic group by calculating the significance level of the interaction between positive family history of CVD and ethnicity, using Dutch as a reference group, and showing the ethnicity‐specific estimate of the association of family history of CVD with nonstroke CVD and stroke. The Dutch were chosen as a reference because they are the majority ethnic group in the Netherlands, and most non‐Dutch minority groups are known to display a higher risk of CVD than the Dutch . The results of logistic regressions are reported as odds ratios (ORs) with 95% CIs.…”

Section: Methodsmentioning

confidence: 99%

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Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population

Valerio

Peters

Zwinderman

et al. 2016

JAHA

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BackgroundHypertension alone is a poor predictor of the individual risk of cardiovascular disease. Hereditary factors of which hypertension is merely a marker may explain why some hypertensive individuals appear more susceptible to cardiovascular disease, and why some ethnicities have more often seemingly hypertension‐related cardiovascular disease than others. We hypothesize that, in hypertensive individuals, a positive family history of cardiovascular disease identifies a high‐risk subpopulation.Methods and ResultsHealthy Life in Urban Settings (HELIUS) is a cohort study among participants of Dutch, South‐Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin aged 70 years and younger. In participants with hypertension (n=6467), we used logistic regression to assess the association of family history of cardiovascular disease with prevalent stroke and nonstroke cardiovascular disease, adjusting for sex, age, education, and smoking. To detect ethnic differences, we tested for interaction between family history and ethnicity and stratified the analysis by ethnicity. A positive family history was associated with a higher prevalence of nonstroke cardiovascular disease (odds ratio [OR], 2.05; 95% CI, 1.65–2.54) and stroke (OR, 1.62; 95% CI, 1.19–2.20). The strongest association of family history with nonstroke cardiovascular disease was found among the Dutch (OR, 2.47; 95% CI, 1.37–4.44) and with stroke among the African Surinamese (OR, 2.17; 95% CI, 1.32–3.57). The interaction between family history and African Surinamese origin for stroke was statistically significant.ConclusionsIn multiethnic populations of hypertensive patients, a positive family history of cardiovascular disease may be used clinically to identify individuals at high risk for nonstroke cardiovascular disease regardless of ethnic origin and African Surinamese individuals at high risk for stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population

Valerio

Peters

Zwinderman

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…In the Loire Valley atrial fibrillation project, the relative risks of major bleeding also did not increase amongst elderly patients with ageing [ 21 ]. The disability and mortality associated with subtypes of stroke could also be related to ethnicity [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population

et al. 2016

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BackgroundThe clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population.AimsOur objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort.MethodsUsing a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated.ResultsAmong 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002–2007, then remained broadly similar between 2008–2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3–1.9 from 2008–2012. Compared to patients age<65, ischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age <65 versus age ≥65: ischaemic: 3.64, 3.33–4.00, vs 14.33, 14.01–14.60; haemorrhagic: 1.09, 1.00–1.10 vs 2.52,2.40–2.70, respectively, both p<0.001). There were no significant differences in haemorrhagic stroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all p<0.05). In subjects age<75 years, CAD (7.17, 4.14–12.37) and diabetes mellitus (3.27, 2.42–4.42) contributed most to the developing of haemorrhagic stroke (all p<0.001). Amongst the very elderly, vascular disease (2.24, 1.49–3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all p<0.001).ConclusionIn this large Chinese cohort, there was an increased risk of ischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population.

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“… 16 This probably results from increased systolic pressure amplification in the setting of low central systolic BP. 17 Finally, while ethnic differences in CVD are well recognized, 18 – 20 data regarding differences in hypertensive phenotypes, including ISH, in young to middle-aged subjects from different ethnic groups are lacking. We previously identified substantial ethnic differences in BP and central haemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study

Schattenkerk

Gorp

Vogt

et al. 2018

Eur J Prev Cardiolog

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BackgroundIsolated systolic hypertension (ISH) of the young has been associated with both normal and increased cardiovascular risk, which has been attributed to differences in central systolic blood pressure and arterial stiffness.MethodsWe assessed the prevalence of ISH of the young and compared differences in central systolic blood pressure and arterial stiffness between ISH and other hypertensive phenotypes in a multi-ethnic population of 3744 subjects (44% men), aged <40 years, participating in the HELIUS study.ResultsThe overall prevalence of ISH was 2.7% (5.2% in men and 1.0% in women) with the highest prevalence in individuals of African descent. Subjects with ISH had lower central systolic blood pressure and pulse wave velocity compared with those with isolated diastolic or systolic-diastolic hypertension, resembling central systolic blood pressure and pulse wave velocity values observed in subjects with high-normal blood pressure. In addition, they had a lower augmentation index and larger stroke volume compared with all other hypertensive phenotypes. In subjects with ISH, increased systolic blood pressure amplification was associated with male gender, Dutch origin, lower age, taller stature, lower augmentation index and larger stroke volume.ConclusionISH of the young is a heterogeneous condition with average central systolic blood pressure values comparable to individuals with high-normal blood pressure. On an individual level ISH was associated with both normal and raised central systolic blood pressure. In subjects with ISH of the young, measurement of central systolic blood pressure may aid in discriminating high from low cardiovascular risk.

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Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

Cited by 53 publications

References 33 publications

Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population

Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population

Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population

Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study

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