Let’s Talk About Race and Stroke Recurrence

There has been a growing body of evidence pointing to potential differences in outcomes of stroke based on race/ethnicity. Recent investigations by Hao et al1, presented at the ISC 19, examined ethnic variation in stroke recurrence, from the angle of intracranial atherosclerotic stenosis [ICAS]. ICAS is estimated to be the underlying pathology in about 15% of ischemic stroke patients2, and is associated with high risk of stroke recurrence even with utmost medical treatment1. The investigators of this study included patients with ICAS in major vessels with >50% stenosis identified on Magnetic resonance angiography or computed tomography angiography. The authors observed higher rate of 3-months as well as long-term recurrence among non-White compared to White patients, although this did not reach statistical significance, possibly due to insufficient power.

Going from ischemic stroke [IS] to intracerebral hemorrhage [ICH], King et al3 assessed recurrence of ICH based on race/ethnicity. They used comprehensive claims data that included hospital discharges in California between 2005-2011. The authors included patients who survived to discharge. Similar to what has been observed in IS, King et al found higher rates of ICH recurrence among Black and Asian compared to White patients.

There are some suggestions on potential explanations on those differences based on the burden of specific clinical conditions by race/ethnicity, such as hypertension4 and chronic kidney disease as reported by Hao et al1. However, this is an area that needs further investigations in representative samples of patients.



[1] Hao, Qing, et al. “Abstract TP157: Ethnic Difference in Stroke Recurrence for Patients With Intracranial Atherosclerotic Stenosis.” Stroke 50.Suppl_1 (2019): ATP157-ATP157.

[2] Bose, Arani, et al. “A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study.” Stroke 38.5 (2007): 1531-1537.

[3] King, Zachary A., et al. “Abstract WMP97: Racial/Ethnic Disparities in the Risk of Intracerebral Hemorrhage Recurrence.” Stroke 50.Suppl_1 (2019): AWMP97-AWMP97.

[4] Rodriguez-Torres, Axana, et al. “Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals.” Neurology 91.1 (2018): e37-e44.