Racial differences in thoracic aorta atherosclerosis among ischemic stroke patients.
OBJECTIVE
Atherosclerosis of the thoracic aorta is an independent risk factor for stroke. There is little information on the impact of race in the prevalence of thoracic aorta atherosclerotic plaques among ischemic stroke patients. This study was an attempt to objectively assess the prevalence, thickness, and burden of thoracic aorta atherosclerotic plaques in a large population of ischemic stroke patients and to compare the differences between American blacks and whites.


METHODS
This is a retrospective study of clinical data and transesophageal echocardiography (TEE) of 1553 ischemic stroke patients (664 blacks, 889 whites) over a period of 4.5 years. Atherosclerotic plaque prevalence, thickness, morphology, and burden (sum of maximum thickness in ascending aorta [AA], aortic arch [AO], and descending aorta [DA]) were assessed with TEE. Charts were reviewed for clinical information.


RESULTS
Age and sex were similar among blacks and whites. Analyses of clinical data found that blacks had significantly higher hypertension (odds ratio [OR], 2.61; P<0.0001) and diabetes mellitus (OR, 1.99; P<0.0001) and significantly lower coronary artery disease (OR, 0.75; P=0.017) and carotid artery disease (OR, 0.62; P=0.0008) compared with whites. TEE showed that whites had significantly greater plaque prevalence (AA: OR, 1.37; P=0.04; AO: OR, 1.26; P=0.03; DA: OR, 1.39; P=0.002) and plaque burden (blacks, 4.28 mm; whites, 4.97 mm; P=0.007). Whites also had a trend of increased complex plaques and plaques >4 mm thick in all regions of the thoracic aorta.


CONCLUSIONS
Among ischemic stroke patients, blacks had a lower prevalence of extra cranial atherosclerotic disease even though they had significantly higher hypertension and diabetes mellitus compared with whites. This difference cannot be explained by the existing risk factors in ischemic stroke patients.
Gupta
Vishal
V
Heart Station/Echocardiography Laboratories, University of Alabama, Birmingham 35249, USA.
Nanda
Navin C
NC
Yesilbursa
Dilek
D
Huang
Wen Ying
WY
Gupta
Vijaya
V
Li
Qing
Q
Gomez
Camilo R
CR
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama / Q000453:epidemiology / Q000208:ethnology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000235:genetics*; D044383:Black People / Q000235:genetics; D002545:Brain Ischemia / Q000453:epidemiology / Q000235:genetics*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D044469:Racial Groups / Q000235:genetics*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000235:genetics*; D044465:White People / Q000235:genetics / Q000706:statistics & numerical data