22. European Stroke Conference 272 Etiology of stroke and risk factors Stroke in South Asians - a study from the Indian subcontinent and the United Kingdom Z. Chen1, M.S. Khan2, S. Yadav3, A. Maheshwari4, T. Fernando5, R. de Silva6, R. Gamage7, K. Prasad8, P. Sharma9 Imperial College Cerebrovascular Research Unit, Imperial College London, London, UNITED KINGDOM1, Imperial College Cerebrovascular Research Unit, Imperial College London, London, UNITED KINGDOM2, Imperial College Cerebrovascular Research Unit, Imperial College Lon-don, London, UNITED KINGDOM3, All-India Institute of Medical Sciences, New Delhi, INDIA4, University of Sri Jayewardenepura, Nugegoda, SRI LANKA5, University of Sri Jayewardenepura, Nugegoda, SRI LANKA6, National Hospital of Sri Lanka, Colombo, SRI LANKA7, All-India In-stitute of Medical Sciences, New Delhi, INDIA8, Imperial College Cerebrovascular Research Unit, Imperial College London, London, UNITED KINGDOM9 BACKGROUND Stroke incidence is rising in South Asia and also in British South Asian (BA) migrants compared to European counterparts. Despite this, stroke in South Asians remains poorly characterised. We as-sessed stroke characteristics in South Asians in the Indian subcontinent (SA), BAs and Europeans. METHOD We set up a DNA biobank of highly-characterised neuroimaging-confirmed stroke patients and matched SA controls. 1030 SA, 654 European and 200 BA cases were recruited from 15 centres across UK, India and Sri Lanka. RESULTS The median stroke onset age of 53.2 years in SAs was lower than BAs (64.0 years; p<0.001) and Europeans (71.0 years; p<0.001). Europeans had a lower proportion of haemorrhagic stroke than SAs (p=0.001). Of ischaemic strokes, 47.1% SAs had lacunar infarcts compared to Europeans (18.7%; p<0.001). Adjusted odds ratios for risk factors between SA, BA and European cases and SA controls are summarised in Table 1. Europeans have larger waist hip ratios (+/-SD) than SAs (0.98+/-0.04 compared to 0.90+/-0.00 respectively; p<0.001). From electro- and echocardiogram findings, SAs had significantly higher proportion of left ventricular hypertrophy than Europeans (p=0.004 and p<0.001) supporting the prevalent risk factor of hypertension. BAs had higher mean fasting glucose (7.5mmol/l+/-0.3) than SAs (6.6mmol/l+/-0.1); p=0.018. There was no significant difference in admission National Institute of Health Stroke Scale between SAs, BAs and Europeans. There was no difference in thrombolysis and carotid endarterectomy rates between BAs and Europeans but SAs had significantly fewer of these interventions (p<0.001). 74.9% SAs were on aspirin for primary prevention compared to 29.8% Europeans and 39.7% BAs (both p<0.001). CONCLUSIONS There is a co-dominant effect of increasing age of stroke onset as South Asians migrate to the UK. The main risk factor for stroke in Sas is hypertension and in Bas is diabetes. Most of the attributable risks for stroke in Sas are modifiable. 430 © 2013 S. Karger AG, Basel Scientific Programme 273 Etiology of stroke and risk factors How much is certain when the stroke aetiology is uncertain G. Sirimarco1, P.C. Lavallee2, J. Labreuche3, P. Amarenco4 Bichat Stroke Center, INSERM U-698 and Paris-Diderot Sorbonne University, Paris, FRANCE1, Bichat Stroke Center, INSERM U-698 and Paris-Diderot Sorbonne University, Paris, FRANCE2, Bichat Stroke Center, INSERM U-698 and Paris-Diderot Sorbonne University, Paris, FRANCE3, Bichat Stroke Center, INSERM U-698 and Paris-Diderot Sorbonne University, Paris, FRANCE4 Background The ASCO phenotypic system assigned a degree of likelihood to each potential cause of ischemic stroke describing all underlying vascular diseases in each patient and reducing the group of undetermined aetiology.The revised ASCOD classification has been applied to the AMISTAD co-hort to investigate the overlap of underlying vascular diseases and their prognostic implication. Method A single rater applied ASCOD in the symptomatic Myocardial Ischemia in Stroke and Atheroscle-rotic Disease(AMISTAD),a prospective,single-center study of 405 patients with recent ischemic stroke. Results Atherosclerosis was the most prevalent underlying disease(90% of patients) and the most frequent potential cause of the index stroke(A1=43%; A2=15%). Cardiac pathology was present in 52% of the patients(C1=23%; C2=14%). Small vessel disease was highly prevalent(66% ) but considered as potential or uncertain cause in 13%. In 3% of patients the cause was completely unknown(ASCOD grades=0) and 25% of patients had multiple underlying causes(grade 1 and 2); this rate increased to 80% considering all 3 grades. The main overlap was found between atherosclerosis and cardiac pathology;among patients with C1, atherosclerosis was present in 92% of cases(A1=28%, A2=20%, A3=44% ). Among patients with A1, cardiac pathology was present in 47% of cases(C1=15%, C2=15%, C3=17%). After 3-year follow-up, only grades for cardiac pathology were associated with risk of vascular events;the hazard ratio(95%CI) was 2.80(1.20-6.54) for C3, 3.18(1.36-7.42) for C2 and 5.32(2.49-11.34) for C1. The risk was similar for A and S grades, meaning that the mere pres-ence of atherosclerosis qualify the patient for a high risk. Conclusion ASCOD classification captures and weighes the overlap between the vascular diseases in patients with ischemic stroke. It suggests that underlying causes express several vascular phenotypes that may be associated with a range of vascular risk and require specific therapeutic approaches.
Karger_ESC London_2013
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