RESUMO
BACKGROUND: The heterogeneous nature and determinants of stroke among different Hispanic groups was examined by comparing hospitalized Hispanic stroke patients in Miami, where the Hispanic population is largely of Caribbean origin, to a Mestizo population in Mexico City. METHODS: Consecutive Hispanic patients who were admitted with stroke or transient ischemic attack (TIA) and included in the prospective stroke registries of 2 tertiary care teaching hospitals were studied. Demographic factors, stroke subtypes, vascular risk factors, stroke severity, and outcomes were compared. Vascular risk factor definitions were standardized. RESULTS: A total of 928 patients (520 Mexicans and 408 Miami Hispanics) were analyzed. Mexicans were younger, with a greater proportion of women. More cerebral venous thromboses (CVTs) were admitted in Mexico, while TIA and stroke mimics were more commonly admitted in Miami; cardioembolic strokes were more commonly ascertained in Miami, and more cryptogenic strokes in Mexico. Stroke severity was similar for intracerebral hemorrhages, but more severe ischemic strokes and CVTs were included in the Mexican registry. Outcome at 1 and 3 months was similar in both registries after adjusting for age and baseline stroke severity. After adjusting for age and sex, hypertension, dyslipidemia, and atrial fibrillation were more frequent, and diabetes mellitus was less frequent, among Miami Hispanics compared to Mexicans. CONCLUSIONS: We found significant differences in the frequency of hypertension, diabetes, dyslipidemia, and atrial fibrillation in Miami Hispanics and Mexican stroke patients, highlighting the heterogeneity of the Hispanic ethnic group. Future studies are needed to clarify the relative contribution of genetic and environmental disparities amongst Mexican and Caribbean Hispanic stroke patients.
Assuntos
Disparidades nos Níveis de Saúde , Hispânico ou Latino , Ataque Isquêmico Transitório/etnologia , Grupos Minoritários , Acidente Vascular Cerebral/etnologia , Saúde da População Urbana/etnologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etnologia , Distribuição de Qui-Quadrado , Diabetes Mellitus/etnologia , Dislipidemias/etnologia , Feminino , Florida/epidemiologia , Cardiopatias/etnologia , Hospitalização , Hospitais de Ensino , Humanos , Hipertensão/etnologia , Embolia Intracraniana/etnologia , Trombose Intracraniana/etnologia , Ataque Isquêmico Transitório/diagnóstico , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Prognóstico , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Centros de Atenção Terciária , Fatores de Tempo , Trombose Venosa/etnologiaRESUMO
OBJECTIVES: To describe clinical, radiological findings, and outcome in a multiethnic population of stroke survivors with basilar artery occlusive disease (BAOC). METHODS: Forty patients with infarcts in the basilar artery (BA) territory, alive 30 days after the ictus, participated in the study. BA stenosis (>50%) or occlusion was shown by magnetic resonance or digital subtraction angiography in all patients. Demographical, clinical and radiological characteristics were described. Modified Rankin Scale (MRS) scores at 30 days and 6 months after the ischemic event were evaluated. Association between demographical, clinical, radiological features and outcome were analyzed with Chi-square and Fisher's exact tests. MRS scores at 30 days and 6 months were compared with the Wilcoxon test. RESULTS: Sixty percent of the patients were men, and 33% were Afro-Brazilian. Mean age was 55.8+/-12.9 years. Most (90%) had multiple vascular risk factors. Stroke was preceded by TIA in 48% of the patients, and 80% had a history of arterial hypertension. The most common neurological symptom was vertigo/dizziness (60%) and the sign, hemiparesis (60%). Most of the infarcts were located in the pons (85%) and the BA middle third was the most frequently affected segment (33%). BA occlusion occurred in 58% of the patients. More severe vascular occlusive lesions were present in Whites (p=0.002) and in patients with involvement of the middle third of the BA (p=0.021). Large-artery atherosclerosis was the most common stroke etiology (88%) and was more frequent in older patients (p<0.001). Most patients were treated with anticoagulation. MRS scores improved significantly at 6 months (p<0.001); at this time, 78% of the patients had MRS scores between 0 and 2. CONCLUSIONS: We observed different results compared with other series: greater proportion of Afro-descendents, higher frequency of atherosclerosis and BA occlusion. Rates of preceding TIAs and good outcome at 6 months were similar to previously published data. These results represent a step forward towards understanding BAOC in a multiethnic context.
Assuntos
Arteriopatias Oclusivas/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/etiologia , Sobreviventes/estatística & dados numéricos , Insuficiência Vertebrobasilar/epidemiologia , Adulto , Fatores Etários , Idoso , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/etnologia , Arteriopatias Oclusivas/fisiopatologia , População Negra/estatística & dados numéricos , Brasil/epidemiologia , Angiografia Cerebral , Tontura/etiologia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Ataque Isquêmico Transitório/etnologia , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/etnologia , Vertigem/etiologiaRESUMO
Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurologists masked to subjects' ethnicity. From January 2000 to December 2002, 2,350 cerebrovascular events occurred. Of the completed strokes, 53% were in Mexican Americans. The crude cumulative incidence was 168/10,000 in Mexican Americans and 136/10,000 in non-Hispanic Whites. Mexican Americans had a higher cumulative incidence for ischemic stroke (ages 45-59 years: risk ratio = 2.04, 95% confidence interval: 1.55, 2.69; ages 60-74 years: risk ratio = 1.58, 95% confidence interval: 1.31, 1.91; ages >or=75 years: risk ratio = 1.12, 95% confidence interval: 0.94, 1.32). Intracerebral hemorrhage was more common in Mexican Americans (age-adjusted risk ratio = 1.63, 95% confidence interval: 1.24, 2.16). The subarachnoid hemorrhage age-adjusted risk ratio was 1.57 (95% confidence interval: 0.86, 2.89). Mexican Americans experience a substantially greater ischemic stroke and intracerebral hemorrhage incidence compared with non-Hispanic Whites. As the Mexican-American population grows and ages, measures to target this population for stroke prevention are critical.
Assuntos
Americanos Mexicanos/estatística & dados numéricos , Acidente Vascular Cerebral/etnologia , População Branca/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/etnologia , Fibrinolíticos/uso terapêutico , Humanos , Incidência , Ataque Isquêmico Transitório/etnologia , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Vigilância da População , Fatores de Risco , Texas/epidemiologiaRESUMO
BACKGROUND: Differences in risk factor prevalence and distribution of atherosclerotic cerebrovascular disease have been reported among different racial-ethnic groups. Identification of stroke syndromes and risk factors specific to the Puerto Rican male population should lead to more effective diagnosis, treatment, and prevention programs. METHODS: We prospectively and consecutively evaluated 118 Hispanic male veterans admitted to our Stroke Unit from June 1994 to September 1995. RESULTS: Ninety patients (76%) had an ischemic infarct, 26 (22%) had a transient ischemic attack, and 2 (2%) had an intracerebral and/or subarachnoid hemorrhage. Hypertension was the most common risk factor. Echocardiographic studies were done in 64% of the patients, and the most common findings were concentric left ventricular hypertrophy and diastolic dysfunction. Cerebral angiography was done in 40 cases, and findings were abnormal in 32 (80%). CONCLUSIONS: We believe this is the largest descriptive study of Hispanic male veterans with stroke syndromes. It provides baseline data to serve as a comparison group for future research.