. 2017 May;48(5):1169-1175.

doi: 10.1161/STROKEAHA.116.015937. Epub 2017 Apr 7.

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

Mayowa Owolabi¹, Fred Sarfo¹, Virginia J Howard¹, Marguerite R Irvin¹, Mulugeta Gebregziabher¹, Rufus Akinyemi¹, Aleena Bennett¹, Kevin Armstrong¹, Hemant K Tiwari¹, Albert Akpalu¹, Kolawole W Wahab¹, Lukman Owolabi¹, Bimbo Fawale¹, Morenikeji Komolafe¹, Reginald Obiako¹, Philip Adebayo¹, Jennifer M Manly¹, Godwin Ogbole¹, Ezinne Melikam¹, Ruth Laryea¹, Raelle Saulson¹, Carolyn Jenkins¹, Donna K Arnett¹, Daniel T Lackland¹, Bruce Ovbiagele², George Howard¹; SIREN-REGARDS Collaboration (Stroke Investigative Research and Educational Network–Reasons for Geographic and Racial Differences in Stroke)

Affiliations

¹ 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.).
² 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.). ovibes@musc.edu.

PMID: 28389611
PMCID: PMC5404953
DOI: 10.1161/STROKEAHA.116.015937

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

Mayowa Owolabi et al. Stroke. 2017 May.

. 2017 May;48(5):1169-1175.

doi: 10.1161/STROKEAHA.116.015937. Epub 2017 Apr 7.

Authors

Affiliations

¹ 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.).
² 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.). ovibes@musc.edu.

PMID: 28389611
PMCID: PMC5404953
DOI: 10.1161/STROKEAHA.116.015937

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 (P<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; P<0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; P<0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; P<0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; P<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.

Keywords: case–control study; cohort study; death; risk factors; stroke.

PubMed Disclaimer

Cited by

Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension.
Sarfo FS, Mobula LM, Sarfo-Kantanka O, Adamu S, Plange-Rhule J, Ansong D, Gyamfi RA, Duah J, Abraham B, Ofori-Adjei D. Sarfo FS, et al. J Neurol Sci. 2019 Jan 15;396:140-147. doi: 10.1016/j.jns.2018.11.017. Epub 2018 Nov 15. J Neurol Sci. 2019. PMID: 30471633 Free PMC article.
Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa.
Kazadi Kabanda I, Kiangebeni Ngonzo C, Emeka Bowamou CK, Divengi Nzambi JP, Kiatoko Ponte N, Tuyinama Madoda O, Nkodila Natuhoyila A, M'buyamba-Kabangu JR, Longo-Mbenza B, Banzulu Bomba D, Kianu Phanzu B. Kazadi Kabanda I, et al. Heliyon. 2024 Mar 24;10(7):e28311. doi: 10.1016/j.heliyon.2024.e28311. eCollection 2024 Apr 15. Heliyon. 2024. PMID: 38571603 Free PMC article.
Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study.
Sarfo FS, Ovbiagele B, Matthew OA, Akpalu A, Wahab K, Obiako R, Owolabi L, Asowata O, Ogbole G, Komolafe M, Akinyemi R, Owolabi M; SIREN. Sarfo FS, et al. J Neurol Sci. 2020 Nov 15;418:117158. doi: 10.1016/j.jns.2020.117158. Epub 2020 Sep 28. J Neurol Sci. 2020. PMID: 33002758 Free PMC article.
Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown.
Youkee D, Deen GF, Baldeh M, Conteh ZF, Fox-Rushby J, Gbessay M, Johnson J, Langhorne P, Leather AJ, Lisk DR, Marshall IJ, O'Hara J, Pessima S, Rudd A, Soley-Bori M, Thompson M, Wafa H, Wang Y, Watkins CL, Williams CE, Wolfe CD, Sackley CM. Youkee D, et al. Int J Stroke. 2023 Jul;18(6):672-680. doi: 10.1177/17474930231164892. Epub 2023 Mar 25. Int J Stroke. 2023. PMID: 36905336 Free PMC article.
Lifestyles correlate with stroke recurrence in Chinese inpatients with first-ever acute ischemic stroke.
Huang ZX, Lin XL, Lu HK, Liang XY, Fan LJ, Liu XT. Huang ZX, et al. J Neurol. 2019 May;266(5):1194-1202. doi: 10.1007/s00415-019-09249-5. Epub 2019 Feb 19. J Neurol. 2019. PMID: 30847644

See all "Cited by" articles

References

1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–254. - PMC - PubMed
1. Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organ. 2016;94:634–634A. - PMC - PubMed
1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population data. Lancet. 2006;367:1747–1757. - PubMed
1. Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, et al. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr. 2015;26:S27–S38. - PMC - PubMed
1. Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, et al. Global stroke statistics. Int J Stroke. 2014;9:6–18. - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Similar articles

Cited by

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract

Similar articles

Cited by

References

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical