Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Waddy
Salina P
SP
Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA. swaddy@emory.edu
Cotsonis
George
G
Lynn
Michael J
MJ
Frankel
Michael R
MR
Chaturvedi
Seemant
S
Williams
Janice E
JE
Chimowitz
Marc
M
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D044383:Black People; D002170:Canada / Q000453:epidemiology; D002533:Cerebral Angiography; D003251:Constriction, Pathologic; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D044465:White People; D001741:Black or African American
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin