Zhang Ying, Galloway James M, Welty Thomas K, Wiebers David O, Whisnant Jack P, Devereux Richard B, Kizer Jorge R, Howard Barbara V, Cowan Linda D, Yeh Jeunliang, Howard W James, Wang Wenyu, Best Lyle, Lee Elisa T
Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA.
Circulation. 2008 Oct 7;118(15):1577-84. doi: 10.1161/CIRCULATIONAHA.108.772285. Epub 2008 Sep 22.
There are few published data on the incidence of fatal and nonfatal stroke in American Indians. The aims of this observational study were to determine the incidence of stroke and to elucidate stroke risk factors among American Indians.
This report is based on 4549 participants aged 45 to 74 years at enrollment in the Strong Heart Study, the largest longitudinal, population-based study of cardiovascular disease and its risk factors in a diverse group of American Indians. At baseline examination in 1989 to 1992, 42 participants (age- and sex-adjusted prevalence proportion 1132/100 000, adjusted to the age and sex distribution of the US adult population in 1990) had prevalent stroke. Through December 2004, 306 (6.8%) of 4507 participants without prior stroke suffered a first stroke at a mean age of 66.5 years. The age- and sex-adjusted incidence was 679/100 000 person-years. Nonhemorrhagic cerebral infarction occurred in 86% of participants with incident strokes; 14% had hemorrhagic stroke. The overall age-adjusted 30-day case-fatality rate from first stroke was 18%, with a 1-year case-fatality rate of 32%. Age, diastolic blood pressure, fasting glucose, hemoglobin A(1c,) smoking, albuminuria, hypertension, prehypertension, and diabetes mellitus were risk factors for incident stroke.
Compared with US white and black populations, American Indians have a higher incidence of stroke. The case-fatality rate for first stroke is also higher in American Indians than in the US white or black population in the same age range. Our findings suggest that blood pressure and glucose control and smoking avoidance may be important avenues for stroke prevention in this population.
关于美国印第安人致命性和非致命性卒中发病率的公开数据较少。这项观察性研究的目的是确定美国印第安人中卒中的发病率，并阐明卒中的危险因素。
本报告基于“强心研究”中4549名年龄在45至74岁之间的参与者，该研究是针对不同美国印第安人群体进行的最大规模的心血管疾病及其危险因素的纵向、基于人群的研究。在1989年至1992年的基线检查中，有42名参与者（年龄和性别调整后的患病率为1132/100000，根据1990年美国成年人口的年龄和性别分布进行调整）患有卒中。截至2004年12月，4507名无既往卒中史的参与者中有306人（6.8%）在平均年龄66.5岁时发生了首次卒中。年龄和性别调整后的发病率为679/100000人年。86%的卒中患者发生非出血性脑梗死；14%为出血性卒中。首次卒中的总体年龄调整后30天病死率为18%，1年病死率为32%。年龄、舒张压、空腹血糖、糖化血红蛋白、吸烟、蛋白尿、高血压、高血压前期和糖尿病是卒中发生的危险因素。
与美国白人和黑人相比，美国印第安人的卒中发病率更高。美国印第安人首次卒中的病死率也高于同年龄范围的美国白人和黑人。我们的研究结果表明，控制血压和血糖以及避免吸烟可能是该人群预防卒中的重要途径。
