Kevin O’Connor, MD

Aradine EM, Ryan KA, Cronin CA, Wozniak MA, Cole JW, Chaturvedi S, Dutta TLM, Hou Y, Mehndiratta P, Motta M, et al. Black-White Differences in Ischemic Stroke Risk Factor Burden in Young Adults. Stroke. 2022;53:e66–e69.

Aradine et al. explore differences in diabetes, hypertension, and smoking in Black patients and White patients as risk factors for ischemic stroke using data from the Stroke Prevention in Young Adults Study. The study population (1044 cases and 1099 controls, aged 15-49 years) was recruited from first-time ischemic stroke patients in the Baltimore, Maryland, and Washington, DC, area between 1992 and 2008.

Black patients, regardless of gender, had a higher prevalence of diabetes, hypertension, and smoking than White patients. There was no significant difference in odds ratio (OR) for diabetes among men (Black OR 3.2, versus White OR, 3.6; P=0.77) or women (Black OR, 2.7 versus OR, 5.2; P=0.71). Although Black men had a higher OR for hypertension than White men (OR, 3.9 versus OR, 1.8; P=0.0008), there was no significant difference among women (Black OR, 2.4 versus White OR, 3.8; P=0.93). The OR for smoking, however, was higher among White men (OR, 2.2 versus OR, 1.5; P=0.03) and White women (OR, 2.9 versus OR, 1.7; P=0.007).

The authors calculated the population-attributable risk (PAR) percent for each risk factor. Diabetes was a stronger contributor to ischemic stroke risk in Black men (PAR, 17.2% versus PAR, 10.5%) and Black women (PAR, 13.4% versus PAR, 7.4%) compared to White patients. The PAR for hypertension was similarly higher among Black men (PAR, 45.8% versus PAR, 17.2%) and women (PAR, 26.4% versus PAR, 19.3%). Smoking was a stronger contributor to ischemic stroke for White men (PAR, 19.7% versus PAR, 10.1%) and White women (PAR, 32.5% versus PAR, 23.8%) compared to Black patients. 

The study reported higher mean packs of cigarettes per day consumed among White men (1.20 vs 0.65) and White women (1.03 vs 0.76), which likely contributed to their higher OR and PAR compared to Black patients. The authors speculated that the earlier onset of hypertension and its longer duration among Black patients may contribute to their higher OR and PAR. The data highlight the impact of diabetes, hypertension, and smoking as modifiable risk factors for ischemic stroke in young patients. Tailored approaches for primary prevention efforts among Black and White patients, such as hypertension detection and management for Black patients and smoking cessation in White patients, may reduce these risk factors.