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LOS ANGELES—A large survey of Asian Americans suggests that the group experiences more severe ischemic strokes and is less likely to receive IV t-PA than white patients, according to research presented at the International Stroke Conference 2018. Investigators also found that stroke severity declined for whites between 2004 and 2016, but not for Asian Americans.
The research encompassed all self-identified Asian Americans in the Get With the Guidelines stroke database, which is a voluntary quality improvement program begun by the American Heart Association in 2003. The analysis included 64,337 Asian Americans and 1,707,962 white Americans at 2,171 hospitals nationwide that participated in the program from 2004 to 2016.
Largest Analysis of Asian Americans With Stroke
“There have been some limited studies, and studies in Asia, but this is the largest analysis of Asian-American stroke patients,” said Sarah Song, MD, Assistant Professor of Neurology at Rush University Medical Center in Chicago. “I think the most important finding is that they are not getting as much t-PA and [are] having more t-PA complications, such as bleeding more. I think it gives it an urgency that maybe was lacking, an urgency that we really need to address this issue by finding 
One particular finding suggested a need for better education among Asian American communities. Asian Americans were less likely than whites to report a clinical history of having heightened levels of low-density lipoproteins (LDL). Asian Americans “did not know that they had high cholesterol, but they had a higher LDL [cholesterol level] than Caucasians on average,” said Dr. Song. The mean LDL cholesterol value was 101 mg/dL in Asian Americans, compared with 95 mg/dL in white patients, which was a statistically significant difference, said the researchers.
In addition, white patients had higher rates of atrial fibrillation (21.2% vs 16.0%), coronary artery disease (27.8% vs 17.5%), and stenosis (4.7% vs 2.0%), while Asian Americans were more likely to have diabetes (38.0% vs 29.2%). Severe strokes (defined as an NIH Stroke Scale score of 16 or greater) were more common among Asian Americans (odds ratio [OR], 1.35) than whites. After adjusting for stroke severity, the researchers found that Asian Americans were less likely to receive t-PA (OR, 0.90) and more likely to experience symptomatic intracerebral hemorrhage within 36 hours of receiving t-PA (OR, 1.23). “I think that may have something to do with the pathophysiology … that we do not quite understand yet, but we can see there is a problem,” Dr. Song said.
Although in-hospital mortality initially appeared to be higher among Asian Americans, this trend was reversed after researchers corrected the analysis for stroke severity, which suggested better outcome for Asian Americans (OR, 0.95). Some quality-of-care measures also favored Asian Americans, including receipt of stroke education (OR, 1.08), receipt of IV t-PA within 60 minutes of arrival (OR, 1.14), LDL cholesterol documentation (OR, 1.19), and receipt of intensive statin therapy (OR, 1.15). Asian Americans were less likely to receive a CT scan within 25 minutes of arrival, however (OR, 0.92).
Between 2004 and 2016, both groups benefited from similar improvements, but not in the same ways. In 2016, a stroke in a white patient was less likely to be severe than in 2004 (OR, 0.97), while there was no change in Asian Americans (OR, 1.00).
Study Limitations
One study limitation was that participation in the database was voluntary, which could lead to selection bias. Another limitation was that all Asian Americans were combined into one group. Stroke pathophysiology and outcomes may vary between Asian countries.
Still, the study suggests challenges that must be addressed. “I think it highlights the problem that Asian ischemic stroke patients do not do as well, they bleed more, and they receive less t-PA,” said Dr. Song.
—Jim Kling
LOS ANGELES—A large survey of Asian Americans suggests that the group experiences more severe ischemic strokes and is less likely to receive IV t-PA than white patients, according to research presented at the International Stroke Conference 2018. Investigators also found that stroke severity declined for whites between 2004 and 2016, but not for Asian Americans.
The research encompassed all self-identified Asian Americans in the Get With the Guidelines stroke database, which is a voluntary quality improvement program begun by the American Heart Association in 2003. The analysis included 64,337 Asian Americans and 1,707,962 white Americans at 2,171 hospitals nationwide that participated in the program from 2004 to 2016.
Largest Analysis of Asian Americans With Stroke
“There have been some limited studies, and studies in Asia, but this is the largest analysis of Asian-American stroke patients,” said Sarah Song, MD, Assistant Professor of Neurology at Rush University Medical Center in Chicago. “I think the most important finding is that they are not getting as much t-PA and [are] having more t-PA complications, such as bleeding more. I think it gives it an urgency that maybe was lacking, an urgency that we really need to address this issue by finding
One particular finding suggested a need for better education among Asian American communities. Asian Americans were less likely than whites to report a clinical history of having heightened levels of low-density lipoproteins (LDL). Asian Americans “did not know that they had high cholesterol, but they had a higher LDL [cholesterol level] than Caucasians on average,” said Dr. Song. The mean LDL cholesterol value was 101 mg/dL in Asian Americans, compared with 95 mg/dL in white patients, which was a statistically significant difference, said the researchers.
In addition, white patients had higher rates of atrial fibrillation (21.2% vs 16.0%), coronary artery disease (27.8% vs 17.5%), and stenosis (4.7% vs 2.0%), while Asian Americans were more likely to have diabetes (38.0% vs 29.2%). Severe strokes (defined as an NIH Stroke Scale score of 16 or greater) were more common among Asian Americans (odds ratio [OR], 1.35) than whites. After adjusting for stroke severity, the researchers found that Asian Americans were less likely to receive t-PA (OR, 0.90) and more likely to experience symptomatic intracerebral hemorrhage within 36 hours of receiving t-PA (OR, 1.23). “I think that may have something to do with the pathophysiology … that we do not quite understand yet, but we can see there is a problem,” Dr. Song said.
Although in-hospital mortality initially appeared to be higher among Asian Americans, this trend was reversed after researchers corrected the analysis for stroke severity, which suggested better outcome for Asian Americans (OR, 0.95). Some quality-of-care measures also favored Asian Americans, including receipt of stroke education (OR, 1.08), receipt of IV t-PA within 60 minutes of arrival (OR, 1.14), LDL cholesterol documentation (OR, 1.19), and receipt of intensive statin therapy (OR, 1.15). Asian Americans were less likely to receive a CT scan within 25 minutes of arrival, however (OR, 0.92).
Between 2004 and 2016, both groups benefited from similar improvements, but not in the same ways. In 2016, a stroke in a white patient was less likely to be severe than in 2004 (OR, 0.97), while there was no change in Asian Americans (OR, 1.00).
Study Limitations
One study limitation was that participation in the database was voluntary, which could lead to selection bias. Another limitation was that all Asian Americans were combined into one group. Stroke pathophysiology and outcomes may vary between Asian countries.
Still, the study suggests challenges that must be addressed. “I think it highlights the problem that Asian ischemic stroke patients do not do as well, they bleed more, and they receive less t-PA,” said Dr. Song.
—Jim Kling
LOS ANGELES—A large survey of Asian Americans suggests that the group experiences more severe ischemic strokes and is less likely to receive IV t-PA than white patients, according to research presented at the International Stroke Conference 2018. Investigators also found that stroke severity declined for whites between 2004 and 2016, but not for Asian Americans.
The research encompassed all self-identified Asian Americans in the Get With the Guidelines stroke database, which is a voluntary quality improvement program begun by the American Heart Association in 2003. The analysis included 64,337 Asian Americans and 1,707,962 white Americans at 2,171 hospitals nationwide that participated in the program from 2004 to 2016.
Largest Analysis of Asian Americans With Stroke
“There have been some limited studies, and studies in Asia, but this is the largest analysis of Asian-American stroke patients,” said Sarah Song, MD, Assistant Professor of Neurology at Rush University Medical Center in Chicago. “I think the most important finding is that they are not getting as much t-PA and [are] having more t-PA complications, such as bleeding more. I think it gives it an urgency that maybe was lacking, an urgency that we really need to address this issue by finding
One particular finding suggested a need for better education among Asian American communities. Asian Americans were less likely than whites to report a clinical history of having heightened levels of low-density lipoproteins (LDL). Asian Americans “did not know that they had high cholesterol, but they had a higher LDL [cholesterol level] than Caucasians on average,” said Dr. Song. The mean LDL cholesterol value was 101 mg/dL in Asian Americans, compared with 95 mg/dL in white patients, which was a statistically significant difference, said the researchers.
In addition, white patients had higher rates of atrial fibrillation (21.2% vs 16.0%), coronary artery disease (27.8% vs 17.5%), and stenosis (4.7% vs 2.0%), while Asian Americans were more likely to have diabetes (38.0% vs 29.2%). Severe strokes (defined as an NIH Stroke Scale score of 16 or greater) were more common among Asian Americans (odds ratio [OR], 1.35) than whites. After adjusting for stroke severity, the researchers found that Asian Americans were less likely to receive t-PA (OR, 0.90) and more likely to experience symptomatic intracerebral hemorrhage within 36 hours of receiving t-PA (OR, 1.23). “I think that may have something to do with the pathophysiology … that we do not quite understand yet, but we can see there is a problem,” Dr. Song said.
Although in-hospital mortality initially appeared to be higher among Asian Americans, this trend was reversed after researchers corrected the analysis for stroke severity, which suggested better outcome for Asian Americans (OR, 0.95). Some quality-of-care measures also favored Asian Americans, including receipt of stroke education (OR, 1.08), receipt of IV t-PA within 60 minutes of arrival (OR, 1.14), LDL cholesterol documentation (OR, 1.19), and receipt of intensive statin therapy (OR, 1.15). Asian Americans were less likely to receive a CT scan within 25 minutes of arrival, however (OR, 0.92).
Between 2004 and 2016, both groups benefited from similar improvements, but not in the same ways. In 2016, a stroke in a white patient was less likely to be severe than in 2004 (OR, 0.97), while there was no change in Asian Americans (OR, 1.00).
Study Limitations
One study limitation was that participation in the database was voluntary, which could lead to selection bias. Another limitation was that all Asian Americans were combined into one group. Stroke pathophysiology and outcomes may vary between Asian countries.
Still, the study suggests challenges that must be addressed. “I think it highlights the problem that Asian ischemic stroke patients do not do as well, they bleed more, and they receive less t-PA,” said Dr. Song.
—Jim Kling