Kevin Agostino NOSM Medical Student

Dr. Saleem Malik Associate Professor NOSM

What is a Stroke (CVA)?

Sudden loss of blood circulation to an area of the brain

May/may not result in a loss of neurologic function

Classified into:HemorrhagicIschemic

Classification of Stroke (CVA)

HemorrhagicIntracerebral HemorrhageSubarachnoid Hemorrhage

IschemicTransient Ischemic AttackThrombotic StrokeEmbolic StrokeSystemic Hypoperfusion

Traditional Risk Factors

Diabetes

Hyperlipidemia

Hypertension

Atrial Fibrillation

Smoking

Genetics

Rationale

Few studies exist

Risks associated with cerebrovascular disease higher in the Aboriginal population

Goals The goals of this study were to:

Assess the demographics

Understand roles of underlying conditions and risk factors

Explore presentation of cerebrovascular disease

Assess mortality rate

Compared to non-Aboriginal population

Methods

Three Northern Ontario Stroke hospitals

Registry of the Canadian Stroke Network (RCSN) was analyzed to determine:

DemographicsRisk factors Presentation Roles of underlying conditionsRankin score upon discharge Seven-day mortality

Subjects

2,721 stroke subjects from Northern Ontario inputted into the RCSN database

The community consultation process was undertaken

Three Aboriginal liaisons

Results

Ethnicity of Patient Population with Stroke:

70% Aboriginal1% Asian2% Caribbean19% Caucasian1% East Indian2% Hispanic1% Pacific Islander4% other

Results Mean age of stroke:

Aboriginal males: 62.45 yrs Males in other population: 70.31 yrs

Aboriginal females: 57.07 yrsFemales in other population: 73.75 yrs

Mean age of stroke in both males and females:

Aboriginal population: 60.31 yrs Other population: 71.92 yrs

Results Diabetes:

Aboriginal population: 56.3%Other population: 24.9%

Valvular Heart Disease:Other population: 5.2% Aboriginal population: 0%

Atrial Fibrillation or Flutter:Other population: 14.2% Aboriginal population: 6.8%

Results Hypertension:

Aboriginal population: 65.0% Other population: 61.3%

Hyperlipidemia:Aboriginal population: 33.0% Other population: 27.3%

Chronic congestive heart failure/pulmonary edema:Aboriginal population: 6.8% Other population: 5.8%

Results Deep vein thrombosis/pulmonary embolus:

Other population: 2.3% Aboriginal population: 0%

Coronary artery disease/angina pectoris:Other population: 20.6% Aboriginal population: 19.4%

Previous stroke:Other population: 20.6% Aboriginal population: 18.4%

Peripheral vascular disease, carotid endarterectomy or stenting, and previous TIA: little clinical significance

Results Current smokers:

Aboriginal population: 31.1% Other population: 18.4%

Lifelong non-smokers:Aboriginal population: 53.4% Other population: 62.8%

The Aboriginal population reported alcohol use:more rarely (68.9% vs 58.0%)< 2 drinks/day (5.8% vs 9.9%)2+ drinks/day (8.7% vs 5.7%)

Results Ischemic stroke:

Aboriginal population: 64.1% Other population: 60.4%

Hemorrhagic stroke:Aboriginal population: 11.6% Other population: 9.5%

TIA:Aboriginal population: 22.3% Other population: 29.8%

Conclusions

Mean age of stroke for both Aboriginal males and females combined was lower

Mean age of stroke in Aboriginal females was significantly lower

Most prevalent risk factors:SmokingBinge Drinking

Conclusions

Significant contributors to stroke:DiabetesHypertensionHyperlipidemia

Most prevalent stroke type:Ischemic Stroke

Acknowledgements

The Registry of the Canadian Stroke Network (RCSN)

Northwestern Ontario Regional Stroke Network

Dr. David Howse, Neurology, Medical Director of the Regional Stroke Program

Cheryl Bain, Coordinator RCSN Diane Hiscox, Coordinator of the

Regional Stroke Program