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Predictors of recurrent stroke in African Americans

From the Department of Neurology and Rehabilitation (S.R., D.R., E.H., P.B.G., University of Illinois at Chicago, Chicago, IL; Department of Mathematics and Computer Science (D.R.), Lake Forest College, Lake Forest, IL; Department of Neurology (J.R.B., C.H.), University of Chicago, Chicago, IL; Department of Neurology (S.C.-F.), Saint Louis University Hospital, St. Louis, MO; Departments of Neurology and Ophthalmology (W.L.F.), Virginia Commonwealth University, Richmond, VA; Case Western Reserve (G.F.-L.), Cleveland, OH; Washington University (C.H.), St. Louis, MO; Department of Neurology (J.K.), Mercy Hospital and Medical Center, Chicago, IL; Department of Neurology (P.M.), Henry Ford Hospital, Detroit, MI.

Address correspondence and reprint requests to Dr. Sean Ruland, University of Illinois at Chicago, 912 South Wood Street, Room 855N (m/c 796), Chicago, IL 60612; e-mail: sruland{at}uic.edu

Background: Stroke incidence and mortality are disproportionately higher among African Americans than among whites.

Objective: To describe the recurrent stroke characteristics and determine the predictability of known vascular risk factors for stroke recurrence in African Americans.

Methods: The authors followed 1,809 African Americans in the African-American Antiplatelet Stroke Prevention Study with recent noncardioembolic ischemic stroke for recurrent stroke, recurrent stroke subtype, and disability.

Results: Of the subjects, 10.6% experienced a recurrent stroke during follow-up. The mean interval between eligibility and recurrent stroke was 325 days (median 287 days, SD = 224 days). Stroke recurrence resulted in an average 1.5-point increase in the National Institute of Health Stroke Scale (p < 0.001) and a 3.5-point decrease in modified Barthel Index (p < 0.001). Of previously nondisabled subjects, 48% became disabled or died after stroke recurrence (p < 0.0001). Longitudinal analysis resulted in a hazard for recurrent stroke for each 10-mm Hg increase in systolic blood pressure of 1.103 (95% CI: 1.031 to 1.179, p = 0.004), pulse pressure 1.123 (95% CI: 1.041 to 1.213, p = 0.003), and mean arterial pressure 1.123 (95% CI: 1.001 to 1.260, p = 0.048). Multivariate analysis revealed increases in the recurrent stroke hazard for increases in baseline Glasgow Outcome Score (1.449, 95% CI: 1.071 to 1.961, p = 0.016) and increases in longitudinal pulse pressure (1.009, 95% CI: 1.001 to 1.017, p = 0.029).

Conclusion: Recurrent stroke leads to disability and disability predicts recurrent stroke. Hypertension is the most predictive modifiable stroke risk factor.

Commentary, see page 553

Supported in part by NIH/NINDS RO1 NS33430 to P.B.G.

Disclosure: The authors report no conflicts of interest.

Received October 5, 2005. Accepted in final form June 5, 2006.

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August 22 Highlight and Commentary: Predictors of recurrent stroke in African Americans

Neurology 2006 67: 553. [Full Text]