非洲原住民、非裔美国人和欧裔美国人的中风：种族与地理因素的相互作用

Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors.

作者信息

Owolabi Mayowa, Sarfo Fred, Howard Virginia J, Irvin Marguerite R, Gebregziabher Mulugeta, Akinyemi Rufus, Bennett Aleena, Armstrong Kevin, Tiwari Hemant K, Akpalu Albert, Wahab Kolawole W, Owolabi Lukman, Fawale Bimbo, Komolafe Morenikeji, Obiako Reginald, Adebayo Philip, Manly Jennifer M, Ogbole Godwin, Melikam Ezinne, Laryea Ruth, Saulson Raelle, Jenkins Carolyn, Arnett Donna K, Lackland Daniel T, Ovbiagele Bruce, Howard George

机构信息

From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).

出版信息

Stroke. 2017 May;48(5):1169-1175. doi: 10.1161/STROKEAHA.116.015937. Epub 2017 Apr 7.

DOI:10.1161/STROKEAHA.116.015937

PMID:28389611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5404953/

Abstract

BACKGROUND AND PURPOSE

The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA).

METHODS

SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies.

RESULTS

There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; <0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; <0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; <0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; <0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%).

CONCLUSIONS

Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.

摘要

背景与目的

非洲裔人群中种族和地理因素对中风风险升高的相对贡献尚未明确。我们比较了非洲原住民（IA）、非裔美国人（AA）和欧裔美国人（EA）的中风类型及血管危险因素的作用。

方法

SIREN（中风调查研究与教育网络）是一项在西非开展的大型跨国病例对照研究，西非是71%非裔美国人的祖籍地；而REGARDS（中风地理和种族差异原因）是一项在美国纳入非裔美国人和欧裔美国人的队列研究。通过统一评估和标准定义，我们比较了两项研究中≥55岁急性中风病例的中风类型数据以及已确定的中风危险因素。

结果

有811名非洲原住民、452名非裔美国人和665名欧裔美国人中风患者，平均年龄分别为68.0±9.3岁、73.0±8.3岁和76.0±8.3岁（<0.0001）。与非裔美国人（8%）和欧裔美国人（5.4%）相比，非洲原住民中出血性中风更为常见（27%；<0.001）。腔隙性中风在非洲原住民中更为普遍（47.1%），其次是非裔美国人（35.1%），然后是欧裔美国人（21.0%；<0.0001）。高血压的发生率从高到低依次为非洲原住民（92.8%）、非裔美国人（82.5%）、欧裔美国人（64.2%；<0.0001），糖尿病的情况类似，非洲原住民（38.3%）、非裔美国人（36.8%）、欧裔美国人（21.0%；<0.0001）。病前久坐不动的生活方式在非裔美国人（37.7%）和欧裔美国人（34.0%）中相似，但在非洲原住民中发生率较低（8.0%）。