Abstract 2661: Unique Attributes Of Asian-Indian Stroke/Transient Ischemic Attack (TIA) Patients: Results of a Prospective Multi-ethnic Hospital-based Registry

Abstract

Introduction: The New Jersey Neuroscience Institute (NJNSI) serves the Middlesex County, NJ which, has a population of 750,000 (68.4% white, 7.3% Asian-Indian, 9.1% African-American, 15.2% others; 13.6% Hispanic of any race, based on 2000 US Census). This prospective multi-ethnic hospital-based registry provides a unique opportunity to study Asian-Indian stroke/TIA patients. Hypothesis: There are differences of stroke risk factors/subtypes between Asian-Indian and Caucasian stroke/TIA patient groups, in light of similar differences noted in the African-American and Hispanic groups individually in relation to the Caucasian group. Methods: Between 1998 and 2009, data on stroke risk factors and stroke subtypes were collected on 1100 consecutive stroke/TIA patients (1037 or 94.3% non-Hispanic; 63 or 5.7% Hispanic) admitted to the NJNSI. Of the non-Hispanics, 768 (74.1%) were Caucasian, 99 (9.6%) Asian-Indian, 139 (13.4%) African-American, 31 (3.0%) were others. Stroke risk factors assessed included age, gender, hypertension, diabetes, atrial fibrillation evaluated by 48-hour Holter monitor, hyperlipidemia evaluated by fasting lipid profile, prevalent coronary artery disease, smoking history, alcohol use, carotid stenosis (>70%) evaluated by duplex ultrasound, fasting homocysteine level and stroke subtypes (using TOAST classification). Asian-Indians, African-American and Hispanic groups were individually compared with the Caucasian group (control) in this study using odds ratio (OR) analyses and X2 test for categorical variables and t-test for continuous variables. Results: The Asian-Indian group was younger (66±12 vs 72±14, p <0.001), higher proportion of males (OR 2.1, p=0.001) and diabetes (OR 2.3, p< 0.001); lower proportion of atrial fibrillation (OR 0.2, p<0.001), smokers (OR 0.3, p<0.001), Alcohol users (OR 0.4, p=0.003) and higher fasting plasma homocysteine level (17.2±20.3 vs 11.9±7.4, p=0.002). There were fewer strokes related to cardioembolism (OR 0.2, p<0.0001) and a higher number of strokes related to small vessel occlusive disease (OR 2.4, p = 0.001). The African-American group had lower proportion of carotid stenosis (OR 0.5, p=0.007) and atrial fibrillation (OR 0.6, p=0.034). African-American group had higher levels of fasting triglyceride level (Median 92 vs 122 mg/dL). The Hispanic group resembled the Asian-Indian group in that they were younger (64±16 vs 72±14, p< 0.001), had a higher proportion of diabetes (OR 1.7, p=0.039), lower proportion of atrial fibrillation (OR 0.5, p=0.037) than the Caucasian group. Conclusions: The Asian-Indian stroke/TIA group in this community has unique attributes in respect to stroke risk factors and stroke subtype. There are few similarities in the stroke risk factors with the Hispanic stroke/TIA group.