Connor Myles D, Modi Girish, Warlow Charles P
Department of Neurosciences, Division of Neurology, University of the Witwatersrand, Johannesburg, South Africa.
Stroke. 2009 Feb;40(2):355-62. doi: 10.1161/STROKEAHA.108.521609. Epub 2008 Dec 18.
The burden of stroke is increasing in Sub-Saharan Africa (SSA) as the population undergoes epidemiological and demographic transition. Little is known about the nature (risk factors, stroke type and subtype, and causes) of stroke in SSA and whether it differs from stroke in high-income populations. We aimed to compare the nature of stroke between black and white populations in South Africa.
We used overlapping sources to ascertain consecutive first-ever-in-a-lifetime stroke patients admitted to Johannesburg Hospital over 23 months. We assessed each patient's demographic details, risk factors, CT confirmed pathological stroke type, ischemic stroke subtype and stroke severity, and compared the nature of stroke between black and white stroke patients.
524 patients with presumed stroke were referred. Of these, 432 were first-ever strokes; 308 patients were black and 76 white. Black patients were significantly younger (mean age 51) than white patients (61). Stroke severity was similar (median NIH stroke score 10; 95% CI 8 to 11). More black than white patients had cerebral hemorrhage (27% versus 15%), lacunar stroke (28% versus 22%) and total anterior circulation infarcts (28% versus 22%). Large vessel atherosclerosis (none detected) and ischemic heart disease were very uncommon (1%) as a cause of stroke in black patients. Hypertension (70% versus 68%) and diabetes (14 versus 15%) were as common in black and white stroke patients, but mean cholesterol levels were lower (4.6 mmol/L; 95% CI 4.3 to 4.9 versus 5.3 mmol/L; 4.8 to 5.7) and cigarette smoking less frequent in black patients (23 versus 54%).
Although this was a hospital-based study, the difference in the nature of stroke between black and white stroke patients likely reflects the profile of stroke risk factors. There is an opportunity to prevent an otherwise inevitable increase in atherosclerotic stroke (and IHD) by targeting dietary and smoking habits in the black South African population.
随着撒哈拉以南非洲地区（SSA）人口经历流行病学和人口结构转变，中风负担日益加重。关于SSA地区中风的本质（风险因素、中风类型和亚型以及病因）以及其与高收入人群中风情况是否存在差异，人们知之甚少。我们旨在比较南非黑人和白人中风患者中风的本质。
我们利用多种来源确定在23个月期间入住约翰内斯堡医院的连续首次发生中风的患者。我们评估了每位患者的人口统计学细节、风险因素、CT确诊的病理性中风类型、缺血性中风亚型和中风严重程度，并比较了黑人和白人中风患者中风的本质。
共转诊了524例疑似中风患者。其中，432例为首次中风；308例患者为黑人，76例为白人。黑人患者（平均年龄51岁）明显比白人患者（61岁）年轻。中风严重程度相似（美国国立卫生研究院中风评分中位数为10；95%置信区间为8至11）。脑出血患者中黑人比白人更多（27%对15%），腔隙性中风患者中黑人比白人更多（28%对22%），完全前循环梗死患者中黑人比白人更多（28%对22%）。在黑人患者中，大动脉粥样硬化（未检测到）和缺血性心脏病作为中风病因非常罕见（1%）。高血压（70%对68%）和糖尿病（14对15%）在黑人和白人中风患者中同样常见，但黑人患者的平均胆固醇水平较低（4.6毫摩尔/升；95%置信区间为4.3至4.9对5.3毫摩尔/升；4.8至5.7），且黑人患者吸烟频率较低（23%对54%）。
尽管这是一项基于医院的研究，但黑人和白人中风患者中风本质的差异可能反映了中风风险因素的情况。通过针对南非黑人的饮食习惯和吸烟习惯进行干预，有可能预防原本不可避免的动脉粥样硬化性中风（和缺血性心脏病）的增加。
