Racial and Ethnic Differences in the Risk of Ischemic Stroke After Nontraumatic Intracerebral Hemorrhage

Simonetto, Marialaura; Sheth, Kevin N; Ziai, Wendy; Iadecola, Costantino; Zhang, Cenai; Murthy, Santosh B.

doi:10.1161/strokeaha.123.043160

Cited by 3 publications

(3 citation statements)

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“…Several recent studies have shown a link between ICH and the subsequent risk of MACCE. [1][2][3][4] This increased risk of MACCE is influenced by demographic factors, mainly race and ethnicity, 7 and ICH-related factors, particularly hematoma location. 8,9 However, since prior studies mainly examined large population cohorts, they lacked important ICH characteristics such as admission hematoma volume and the presence of IVH.…”

Section: Discussionmentioning

confidence: 99%

“…Recent data suggest that Black patients with ICH and those of Hispanic ethnicity have a higher ischemic stroke risk compared with White patients with ICH. 7 Furthermore, hematoma location may play a role in the fact that the risk of MACCE is higher after a lobar ICH, mainly due to a heightened risk of recurrent ICH, while there appears to be a trend toward more ischemic events among patients with a deep ICH. 5,8,9 It is, however, unknown whether other hematoma characteristics, such as hematoma volume, are also associated with ischemic stroke risk.…”

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confidence: 99%

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Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis

Harris,

Kaiser,

Liao

et al. 2024

Stroke

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BACKGROUND: Nontraumatic intracerebral hemorrhage (ICH) is independently associated with a long-term increased risk of major arterial ischemic events. While the relationship between ICH location and ischemic risk has been studied, whether hematoma volume influences this risk is poorly understood. METHODS: We pooled individual patient data from the MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3) and the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) trials. The exposure was hematoma volume, treated as a continuous measure in the primary analysis, and dichotomized by the median in the secondary analyses. The outcome was a symptomatic, clinically overt ischemic stroke, adjudicated centrally within each trial. We evaluated the association between hematoma volume and the risk of an ischemic stroke using Cox regression analyses after adjustment for demographics, vascular comorbidities, and ICH characteristics. RESULTS: Of 1470 patients with ICH, the mean age was 61.7 (SD, 12.8) years, and 574 (38.3%) were female. The median hematoma volume was 17.3 mL (interquartile range, 7.2–35.7). During a median follow-up of 107 days (interquartile range, 91–140), a total of 30 ischemic strokes occurred, of which 22 were in patients with a median ICH volume of ≥17.3 mL and a cumulative incidence of 4.6% (95% CI, 3.1–7.1). Among patients with a median ICH volume <17.3 mL, there were 8 ischemic strokes with a cumulative incidence of 3.1% (95% CI, 1.7–6.0). In primary analyses using adjusted Cox regression models, ICH volume was associated with an increased risk of ischemic stroke (hazard ratio, 1.02 per mL increase [95% CI, 1.01–1.04]). In secondary analyses, ICH volume of ≥17.3 mL was associated with an increased risk of ischemic stroke (hazard ratio, 2.5 [95% CI, 1.1–7.2]), compared with those with an ICH volume <17.3 mL. CONCLUSIONS: In a heterogeneous cohort of patients with ICH, initial hematoma volume was associated with a heightened short-term risk of ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis

Harris,

Kaiser,

Liao

et al. 2024

Stroke

Self Cite

View full text Add to dashboard Cite

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“…4,5 Multiple studies have demonstrated higher incidences of ischemic and hemorrhagic strokes among minority racial and ethnic groups, especially non-Hispanic Black and Hispanic patients. [6][7][8] Moreover, patient access to health care differs among racial and ethnic groups, with White patients being more likely to use medical services compared with Black, Asian, and Hispanic patients. 9,10 This becomes important since the time and quality of treatment significantly impact survival rates and functional long-term recovery.…”

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confidence: 99%

Racial and Ethnic Differences in Mortality and Functional Outcomes Following Aneurysmal Subarachnoid Hemorrhage

Becerril-Gaitan,

Mokua,

Liu

et al. 2024

Stroke

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BACKGROUND: Ischemic and hemorrhagic stroke incidence tends to be higher among minority racial and ethnic groups. The effect of race and ethnicity following an aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. Thus, we aimed to explore the association between race and ethnicity and aSAH outcomes. METHODS: Single-center retrospective review of patients with aSAH from January 2009 to March 2023. Primary outcome was in-hospital mortality. Secondary outcomes included delayed cerebral ischemia, cerebral infarction, radiographic and symptomatic vasospasm, pulmonary complications, epileptic seizures, external ventricular drain placement, and modified Rankin Scale score at discharge and 3-month follow-up. Associations between race and ethnicity and outcomes were assessed using binary and ordinal regression models, with multivariable models adjusted for significant covariates. RESULTS: A total of 1325 patients with subarachnoid hemorrhage presented to our center. Among them, 443 cases were excluded, and data from 882 patients with radiographically confirmed aSAH were analyzed. Distribution by race and ethnicity was 40.8% (n=360) White, 31.4% (n=277) Hispanic, 22.1% (n=195) Black, and 5.7% (n=50) Asian. Based on Hunt-Hess and modified Fisher grade, aSAH severity was similar among groups ( P =0.269 and P =0.469, respectively). In-hospital mortality rates were highest for Asian (14.0%) and Hispanic (11.2%) patients; however, after adjusting for patient sex, age, health insurance, smoking history, alcohol and substance abuse, and aneurysm treatment, the overall likelihood was comparable to White patients. Hispanic patients had higher risks of developing cerebral infarction (adjusted odds ratio, 2.17 [1.20–3.91]) and symptomatic vasospasm (adjusted odds ratio, 1.64 [1.05–2.56]) than White patients and significantly worse discharge modified Rankin Scale scores (adjusted odds ratio, 1.44 [1.05–1.99]). Non-White patients also demonstrated a lower likelihood of 0 to 2 discharge modified Rankin Scale scores (adjusted odds ratio, 0.71 [0.50–0.98]). No significant interactions between race and ethnicity and age or sex were found for in-hospital mortality and functional outcomes. CONCLUSIONS: Our study identified significant differences in cerebral infarction and symptomatic vasospasm risk between Hispanic and White patients following aSAH. A higher likelihood of worse functional outcomes at discharge was found among non-White patients. These findings emphasize the need to better understand predisposing risk factors that may influence aSAH outcomes. Efforts toward risk stratification and patient-centered management should be pursued.

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Interplay between polygenic variants related immune response and lifestyle factors mitigate the chances of stroke in a genome-wide association study

Park

2024

Br J Nutr

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We aimed to investigate the intricate interplay between genetic predisposition and lifestyle factors on stroke. We conducted a comprehensive genome-wide association study(GWAS) to identify the genetic variants linked to stroke in the participants who experienced a stroke event(cases; n=672) and those with no stroke history(non-stroke; n=58,029) in a large hospital-based cohort. Using generalized multifactor dimensionality reduction, we identified genetic variants with interactive effects and constructed polygenic risk scores(PRS) by summing up the risk alleles from the genetic variants. Food intake was measured with a validated semi-quantitative food frequency questionnaire. No significant differences in stroke incidence were seen in demographic variables between the two groups. Among the metabolic indicators, only serum triglyceride levels were higher in males with stroke than those without stroke. The daily nutrient intake, dietary inflammation index, glycemic index, dietary patterns, alcohol consumption, exercise, and smoking did not display associations with the odds ratio for stroke. The stroke-linked genetic variants were related to the interleukin-18(IL-18) pathway. After accounting for covariates, the PRS derived from the 5-, 6-, and 7-single nucleotide polymorphism(SNP) models were positively associated with stroke chance with 2.5-, 2.9-, and 2.8-fold. Furthermore, interactions between genetic predisposition and dietary components, including energy, carbohydrates, n-3 fatty acids, and branched-chain amino acids(BCAAs), that affected odds ratios for stroke were observed. A high intake of energy, carbohydrates, and BCAAs and a low intake of n-3 fatty acids were positively associated with the chances of stroke occurrence. In conclusion, understanding the interaction between genetic variants and lifestyle factors can assist in developing stroke prevention and management strategies.

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Racial and Ethnic Differences in the Risk of Ischemic Stroke After Nontraumatic Intracerebral Hemorrhage

Cited by 3 publications

References 46 publications

Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis

Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis

Racial and Ethnic Differences in Mortality and Functional Outcomes Following Aneurysmal Subarachnoid Hemorrhage

Interplay between polygenic variants related immune response and lifestyle factors mitigate the chances of stroke in a genome-wide association study

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