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Secular trends in the cardiovascular risk profile and mortality of stroke admissions in an inner city, multiethnic population in the United Kingdom (1997–2005)

Journal of Human Hypertension volume 22, pages 18–23 (2008)Cite this article

Abstract

Our objective was to study ethnic differences in the cardiovascular risk profile and mortality of stroke admissions to an inner city teaching hospital serving a multiethnic population in Birmingham, UK, over a 9-year period (1997–2005). Hospital case notes and registry data of 3083 patients admitted with a first onset stroke were reviewed. Secular trends in the prevalence of risk factors (hypertension, diabetes, hyperlipidaemia, atrial fibrillation and myocardial infarction), hospital admission rates and 30-day mortality among Afro-Caribbean, European Caucasian and South Asian ethnic groups were analysed. Between 1997 and 2005, there were 3083 first onset strokes, of whom 47.6% (1595) were men, 9.3% Afro-Caribbean, 57.8% European Caucasian and 15.1% South Asian. There was a significant trend towards a reduction in non-haemorrhagic stroke admissions over the study period (P<0.001), with no ethnic variation (P=0.07). Increases in hypertension and hyperlipidaemia were observed (P<0.001), whereas myocardial infarction showed a decline (P<0.001). Compared to other ethnic groups, South Asian patients were younger on admission (P<0.001), had more hyperlipidaemia (P<0.05) and poorer survival at 30 days (P=002). We conclude that cardiovascular risk profiles among patients admitted with non-haemorrhagic stroke have changed over the last decade. In particular, hyperlipidaemia has increased, especially among South Asians. The reduced decline in stroke admissions and 30-day survival of stroke in South Asians in recent years warrants further investigation and highlights the importance of a targeted health-care approach in the migrant ethnic minorities.

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References

  1. Lip GY, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007; 21: 183–211.

    Article  CAS  PubMed  Google Scholar 

  2. Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, et al., Oxford Vascular Study. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005; 366: 1773–1783.

    Article  CAS  PubMed  Google Scholar 

  3. Wild S, McKeigue P . Cross sectional analysis of mortality by country of birth in England and Wales, 1970–92. BMJ 1997; 314: 705–710.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Raleigh VS, Kiri V, Balarajan R . Variations in mortality from diabetes mellitus, hypertension and renal disease in England and Wales by country of birth. Health Trends 1997; 28: 122–127.

    Google Scholar 

  5. Khattar RS, Swales JD, Senior R, Lahiri A . Racial variation in cardiovascular morbidity and mortality in essential hypertension. Heart 2000; 83: 267–271.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Lane DA, Lip GY, Beevers DG . Ethnic differences in cardiovascular and all-cause mortality in Birmingham, England: the Birmingham Factory Screening Project. J Hypertens 2005; 23: 1347–1353.

    Article  CAS  PubMed  Google Scholar 

  7. Lane DA, Lip GYH . Ethnic differences in hypertension and blood pressure control in the UK. Q J Med 2001; 94: 391–396.

    Article  CAS  Google Scholar 

  8. Cappuccino FP, Barbato A, Kerry SM . Hypertension, diabetes and cardiovascular risk in ethnic minorities in the UK. Br J Diabetes Vasc Dis 2003; 3: 286–293.

    Article  Google Scholar 

  9. Schulz UG, Rothwell PM . Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. Stroke 2003; 34: 2050–2059.

    Article  CAS  PubMed  Google Scholar 

  10. Gillum RF . Epidemiology of stroke in Hispanic Americans. Stroke 1995; 26: 1707–1712.

    Article  CAS  PubMed  Google Scholar 

  11. Gillum RF . Risk factors for stroke in blacks: a critical review. Am J Epidemiol 1999; 150: 1266–1274.

    Article  CAS  PubMed  Google Scholar 

  12. Cruickshank JK, Alleyne SA . Black West Indian and matched white diabetics in Britain compared with diabetics in Jamaica: body mass, blood pressure, and vascular disease. Diabetes Care 1987; 2: 170–179.

    Article  Google Scholar 

  13. Bhatnagar D, Anand IS, Durrington PN, Patel DJ, Wander GS, Mackness MI et al. Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. Lancet 1995; 345: 405–409.

    Article  CAS  PubMed  Google Scholar 

  14. Patel JV, Vyas A, Cruickshank JK, Prabhakaran D, Hughes E, Reddy KS et al. Impact of migration on coronary heart disease risk factors: comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2006; 185: 297–306.

    Article  CAS  PubMed  Google Scholar 

  15. Cruickshank JK, Cooper J, Burnett M, MacDuff J, Drubra U . Ethnic differences in fasting plasma C-peptide and insulin in relation to glucose tolerance and blood pressure. Lancet 1991; 338: 842–847.

    Article  CAS  PubMed  Google Scholar 

  16. Lyratzopoulos G, McElduff P, Heller RF, Hanily M, Lewis PS . Comparative levels and time trends in blood pressure, total cholesterol, body mass index and smoking among Caucasian and South-Asian participants of a UK primary-care based cardiovascular risk factor screening programme. BMC Public Health 2005; 5: 125.

    Article  PubMed Central  PubMed  Google Scholar 

  17. George LM, Maddock K . Accuracy of hospital activity notifications for infectious diseases. BMJ 1979; 1: 1332–1339.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. NHS Strategic Tracing Service. Better information for health where and when it's needed—NHS connecting or health. http://www.connectingforhealth.nhs.uk,accessed on 2/8/2006.

  19. Hatona S . Experiences from a multicenter stroke register: a preliminary report. Bull World Health Organ 1976; 54: 541–553.

    Google Scholar 

  20. National Institute of Clinical Excellence (NICE). National Institute of Clinical Excellence (NICE) guidelines for cardiovascular disease. http://guidance.nice.org.uk/topic/cardiovascular,accessed on 2/8/2006.

  21. British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British Societies guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91: 1–52.

    Article  Google Scholar 

  22. Sharobeem KM, Patel JV, Ritch AES, Gill PS, Lip GYH, Hughes EA . Elevated lipoprotein(a) and apolipoprotein B to AI ratio in South Asian patients with ischaemic stroke. Int J Clin Pract (in press).

  23. Deleu D, Hamad AA, Kamram S, El Siddig A, Al Hail H, Hamdy SM . Ethnic variations in risk factor profile, pattern and recurrence of non-cardioembolic ischemic stroke. Arch Med Res 2006; 37: 655–662.

    Article  PubMed  Google Scholar 

  24. Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA et al. Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE). Indian Heart J 2000; 52: S35–S43.

    CAS  PubMed  Google Scholar 

  25. Sacco RL, Boden-Albala B, Abel G, Lin IF, Elkind M, Hauser WA et al. Race-ethnic disparities in the impact of stroke risk factors: the northern Manhattan stroke study. Stroke 2001; 32: 1725–1731.

    Article  CAS  PubMed  Google Scholar 

  26. Howard G, Howard VJ, Katholi C, Oli MK, Huston S . Decline in US stroke mortality: an analysis of temporal patterns by sex, race, and geographic region. Stroke 2001; 32: 2213–2220.

    Article  CAS  PubMed  Google Scholar 

  27. WHO. WHO STEPwise approach to surveillance. http://www.who.int/chp/steps,accessed on 2/8/2006.

  28. Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD . Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ 1999; 318: 967–971.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Hsu RT, Ardron ME, Brooks W, Cherry D, Taub NA, Botha JL . The 1996 Leicestershire Community Stroke & Ethnicity Study: differences and similarities between South Asian and white strokes. Int J Epidemiol 1999; 28: 853–858.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. University Department of Medicine, City Hospital, Birmingham, UK

    A Gunarathne, J V Patel, R Potluri, E A Hughes & G Y H Lip

  2. Department of Primary Care and General Practice, University of Birmingham Edgbaston, Birmingham, UK

    P S Gill

Authors
  1. A Gunarathne
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  2. J V Patel
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  3. R Potluri
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  4. P S Gill
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  5. E A Hughes
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  6. G Y H Lip
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Correspondence to G Y H Lip.

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This paper was dealt with by a guest editor, Associate Professor Bernard Cheung from the University of Hong Kong, and editorial decisions were independent of the Birmingham-based editor.

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Gunarathne, A., Patel, J., Potluri, R. et al. Secular trends in the cardiovascular risk profile and mortality of stroke admissions in an inner city, multiethnic population in the United Kingdom (1997–2005). J Hum Hypertens 22, 18–23 (2008). https://doi.org/10.1038/sj.jhh.1002265

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  • DOI: https://doi.org/10.1038/sj.jhh.1002265

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