Estol Conrado J, Bath Philip M W, Gorelick Philip B, Cotton Daniel, Martin Renee Hebert
Int J Stroke. 2014 Oct;9 Suppl A100:43-7. doi: 10.1111/ijs.12269. Epub 2014 Mar 18.
Epidemiological studies show that vascular risk factors are the same across the world but their effect vary between different race-ethnic groups. However, few studies have evaluated differences in recurrent stroke rates in various race-ethnicities. In >20 000 patients spanning 35 countries encompassing most race-ethnicities, we evaluated the incidence of ischemic and hemorrhagic strokes and myocardial infarction in patients within the context of the largest secondary stroke prevention trial (Prevention Regimen for Effectively Avoiding Secondary Strokes) to identify any significant differences.
There were 20 332 patients with a recent ischemic stroke randomized in a factorial design to receive the antiplatelet agent clopidogrel vs. aspirin plus extended-release dipyridamole, and 80 mg of the anthypertensive telmisartan vs. placebo. The primary outcome for the trial was the time to any recurrent stroke. Statistical analysis was used to detect race-ethnic differences in recurrent vascular events.
Mean patient age was 66 (±8·6) years and 36% were women. The study included 58% European/Caucasian, 33% Asians, 5% Latin/Hispanic, and 4% Black African. There were 74% of patients that were hypertensive, and average systolic and diastolic blood pressure was 144·1/83·8 mmHg. There was at least one significant difference in the overall test of all race-ethnic groups in myocardial infarction and symptomatic intracerebral hemorrhage occurrence. In the Kaplan-Meier hemorrhage and stroke-free survival curves, Asians showed a significantly higher recurrence of ischemic stroke risk in the 135-150 mmHg and greater than 150 mm Hg blood pressure groups, and a greater risk of hemorrhage recurrence in the greater than 150 mmHg blood pressure group.
We found a significant difference in myocardial infarction and symptomatic intracerebral hemorrhage recurrence among different race-ethnic groups. The risk of recurrent ischemic and hemorrhagic stroke was greater in Asians with high blood pressure.
流行病学研究表明，血管危险因素在全球范围内相同，但其影响在不同种族群体之间存在差异。然而，很少有研究评估不同种族复发性卒中发生率的差异。在涵盖大多数种族的35个国家的20000多名患者中，我们在最大的二级卒中预防试验（有效避免二次卒中预防方案）的背景下，评估了缺血性和出血性卒中和心肌梗死的发生率，以确定是否存在任何显著差异。
20332例近期缺血性卒中患者按析因设计随机分组，分别接受抗血小板药物氯吡格雷与阿司匹林加缓释双嘧达莫，以及80mg降压药替米沙坦与安慰剂。该试验的主要结局是首次复发性卒中的时间。采用统计分析检测复发性血管事件中的种族差异。
患者平均年龄为66（±8.6）岁，36%为女性。该研究纳入了58%的欧洲/白种人、33%的亚洲人、5%的拉丁裔/西班牙裔和4%的非洲黑人。74%的患者患有高血压，平均收缩压和舒张压为144.1/83.8mmHg。在所有种族群体的心肌梗死和症状性脑出血发生率的总体检验中，至少存在一个显著差异。在Kaplan-Meier出血和无卒中生存曲线中，亚洲人在血压为135-150mmHg及高于150mmHg的组中缺血性卒中复发风险显著更高，在血压高于150mmHg的组中出血复发风险更大。
我们发现不同种族群体中心肌梗死和症状性脑出血复发存在显著差异。高血压亚洲人复发性缺血性和出血性卒中的风险更大。
