Koren-Morag Nira, Tanne David, Goldbourt Uri
Division of Epidemiology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Isr Med Assoc J. 2009 Oct;11(10):586-91.
The incidence of stroke varies among ethnically and culturally diverse groups.
To examine the ethnic-geographic patterns of stroke incidence in men and women with coronary heart disease in Israel, focusing on the extent to which this variability can be explained by known differences in risk factors for stroke.
Patients with documented coronary heart disease were followed for 6-8 years for incident cerebrovascular events. Baseline medical evaluation included assessment of vascular risk factors and measurements of blood lipids. Among 15,052 patients, 1110 were identified with any incident ischemic cerebrovascular event by ICD-9 codes, of whom 613 had confirmed ischemic stroke or transient ischemic attack.
A major excess of ischemic cerebrovascular events among Israeli Arab women as compared to males, and an inverse finding among Israeli born Jews, were noted. The high risk in the Arab population in Israel reflected an unfavorable risk profile, since predicted rates by multivariate analysis and observed rates were 69 and 68 per 1000, respectively. High ischemic cerebrovascular event rates were identified among patients born in the Balkan countries and North Africa (89 and 90 per 1000), but unfavorable risk factor levels of these individuals did not explain them. Most trends appeared similar in male and female patients. A comparison of observed and accepted-according-to-risk-profile rates of ischemic cerebrovascular events yielded significant differences (P = 0.04), consistent with an additional role of geographic/ethnic origin resulting from factors that remain unrecognized, or with variables unassessed in this study.
We identified an ethnic diversity in stroke risk among the Israeli born in different parts of the world beyond what could be expected on the basis of differences in known risk factors. These findings call for detailed research aimed at identifying additional differences in the risk profile of patients with atherothrombotic disease exposed to an increased risk of stroke.
中风的发病率在不同种族和文化群体中有所不同。
研究以色列冠心病男性和女性患者中风发病率的种族地理模式，重点关注这种变异性在多大程度上可以由已知的中风危险因素差异来解释。
对有冠心病记录的患者进行6至8年的随访，以观察脑血管事件的发生情况。基线医学评估包括血管危险因素评估和血脂测量。在15052名患者中，根据国际疾病分类第九版（ICD - 9）编码确定有1110例发生了任何缺血性脑血管事件，其中613例确诊为缺血性中风或短暂性脑缺血发作。
与男性相比，以色列阿拉伯女性的缺血性脑血管事件明显过多，而在以色列出生的犹太人中则发现相反的情况。以色列阿拉伯人群的高风险反映了不利的风险特征，因为多变量分析预测率和观察率分别为每1000人69例和68例。在出生于巴尔干国家和北非的患者中发现了较高的缺血性脑血管事件发生率（每1000人89例和90例），但这些个体不利的危险因素水平并不能解释这一现象。大多数趋势在男性和女性患者中似乎相似。缺血性脑血管事件的观察率与根据风险特征接受的率进行比较产生了显著差异（P = 0.04），这与未被认识的因素导致的地理/种族起源的额外作用或本研究中未评估的变量一致。
我们发现在世界各地出生的以色列人中，中风风险存在种族差异，超出了基于已知危险因素差异所预期的范围。这些发现呼吁进行详细研究，以确定暴露于中风风险增加的动脉粥样硬化血栓形成疾病患者风险特征中的其他差异。
