TY - JOUR
T1 - Stroke in Indigenous Africans, African Americans, and European Americans
T2 - Interplay of Racial and Geographic Factors
AU - the SIREN-REGARDS Collaboration (Stroke Investigative Research and Educational Network-Reasons for Geographic and Racial Differences in Stroke)
AU - Owolabi, Mayowa
AU - Sarfo, Fred
AU - Howard, Virginia J.
AU - Irvin, Marguerite R.
AU - Gebregziabher, Mulugeta
AU - Akinyemi, Rufus
AU - Bennett, Aleena
AU - Armstrong, Kevin
AU - Tiwari, Hemant K.
AU - Akpalu, Albert
AU - Wahab, Kolawole W.
AU - Owolabi, Lukman
AU - Fawale, Bimbo
AU - Komolafe, Morenikeji
AU - Obiako, Reginald
AU - Adebayo, Philip
AU - Manly, Jennifer M.
AU - Ogbole, Godwin
AU - Melikam, Ezinne
AU - Laryea, Ruth
AU - Saulson, Raelle
AU - Jenkins, Carolyn
AU - Arnett, Donna K.
AU - Lackland, Daniel T.
AU - Ovbiagele, Bruce
AU - Howard, George
N1 - Funding Information:
The SIREN project (Stroke Investigative Research and Educational Network) is supported by U54HG007479 from the National Institutes of Health as part of the Human Heredity and Health (H3Africa) Consortium. The REGARDS project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background and Purpose - The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA). Methods - SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa - the ancestral home of 71% AA - whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies. Results - There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (P<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; P<0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; P<0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; P<0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; P<0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%). Conclusions - Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.
AB - Background and Purpose - The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA). Methods - SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa - the ancestral home of 71% AA - whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies. Results - There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (P<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; P<0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; P<0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; P<0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; P<0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%). Conclusions - Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.
KW - case-control study
KW - cohort study
KW - death
KW - risk factors
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85017209102&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.116.015937
DO - 10.1161/STROKEAHA.116.015937
M3 - Article
C2 - 28389611
AN - SCOPUS:85017209102
SN - 0039-2499
VL - 48
SP - 1169
EP - 1175
JO - Stroke
JF - Stroke
IS - 5
ER -
