Identifying Genetic and Biological Determinants of Race-Ethnic Disparities in Stroke in the United States

Abstract

In the United States, causes of racial differences in stroke and its risk factors remain only partly understood, and there is a long-standing disparity in stroke incidence and mortality impacting Black Americans. Only half of the excess risk of stroke in the United States Black population is explained by traditional risk factors, suggesting potential effects of other factors including genetic and biological characteristics. Here, we nonsystematically reviewed candidate laboratory biomarkers for stroke and their relationships to racial disparities in stroke. Current evidence indicates that IL-6 (interleukin-6), a proinflammatory cytokine, mediates racial disparities in stroke through its association with traditional risk factors. Only one reviewed biomarker, Lp(a) (lipoprotein[a]), is a race-specific risk factor for stroke. Lp(a) is highly genetically determined and levels are substantially higher in Black than White people; clinical and pharmaceutical ramifications for stroke prevention remain uncertain. Other studied stroke risk biomarkers did not explain racial differences in stroke. More research on Lp(a) and other biological and genetic risk factors is needed to understand and mitigate racial disparities in stroke.

Keywords: biomarker; incidence; interleukin-6; lipoproteins; risk factors.

Figure 1.

Overview of genetic and biological determinants of racial disparities in stroke risk HR: Hazard ratio; RR: relative risk; SES: socio-economic status; IL-6: interleukin-6, WBC: white blood cell count; CRP: C-reactive protein; Lp(a): Lipoprotein(a)