Native Hawaiians have bleeding strokes at earlier age, independent of meth use

American Stroke Association Meeting Report - Abstract WP303 - Embargoed until 7 a.m. HT/Noon ET on Wednesday, Feb. 6, 2013

February 06, 2013

This news release is featured in a news conference at 7 a.m. HT, Wednesday, Feb. 6.
Study Highlights:

Native Hawaiians have more bleeding strokes at an earlier age than other people independent of methamphetamine abuse.
Besides genetics, environmental factors – such as diet, stress, unhealthy lifestyles and a lack of good healthcare could also affect the higher incidences.
Researchers suggest more focus is needed on controlling high blood pressure, diabetes and weight management in this population.

HONOLULU, Feb. 6, 2013 — Native Hawaiians and Pacific Islanders have more bleeding strokes at an earlier age than other people independent of methamphetamine abuse, according to research presented at the American Stroke Association’s International Stroke Conference 2013.
“Drug abuse is a huge problem here and it definitely is a cause of hemorrhagic stroke,” said Kazuma Nakagawa, M.D., lead investigator and assistant professor of medicine at the University of Hawaii. “But Native Hawaiians and Pacific Islanders are experiencing this form of stroke at a younger age even without methamphetamine use. It’s not all about methamphetamines, but possibly due to poor vascular health.”
Intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. It occurs when a weakened blood vessel inside the brain ruptures and leaks blood into surrounding brain tissue.
In a retrospective study of ICH patients treated at an Oahu hospital, Native Hawaiians and Pacific Islanders (NHPI) had five times the risk of ICH stroke before age 45 when compared to non-Hispanic white controls. Of the 384 ICH patients studied in 2006-10, 19 percent were Native Hawaiian/Pacific Islanders, 65 percent were Asians and 16 percent non-Hispanic whites.
Researchers found:

NHPIs were an average 54 years when they had a hemorrhagic stroke compared to 68 years for non-Hispanic whites.
NHPIs had twice the amount of diabetes (36 percent versus 19 percent) and more than twice the number with untreated high blood pressure (32 percent versus 15 percent) when compared to non-Hispanic whites.
Intracerebral hemorrhage before age 45 occurred in 26 percent of NHPIs, 9 percent in Asians and only 6 percent in whites.
Ten percent of NHPI patients tested positive on toxicology screens for methamphetamine use compared to 3 percent of whites and 6 percent of Asians.
Seventeen percent of ICH before age 45 resulted from methamphetamine abuse.

“Forty-one percent of patients experiencing intracerebral hemorrhage before the age of 45 years were Native Hawaiians and Pacific Islanders,” Nakagawa said. “After age 45, only 16 percent were Native Hawaiians and Pacific Islanders.”
Besides genetics, environmental factors – such as diet, stress, unhealthy lifestyles and a lack of good health care – could also affect the higher incidences, he said. “These groups need a different intensity of treatment in the community. There needs to be a focus on controlling hypertension, diabetes and weight management.”
The retrospective study was based on chart reviews in one institution. So researchers are conducting a prospective study to determine the causes of the strokes in young Native Hawaiians and Pacific Islanders.
Cerebral hemorrhage accounts for about 10 percent of 795,000 annual strokes in the United States. This form of stroke is often more severe and disabling than ischemic stroke, which is due to blockage in an artery.
Co-authors are: Megan Vento, B.S.; Matthew A. Koenig, M.D.; Susan M. Asai, R.N.; Cherylee W. Chang, M.D.; and Todd B. Seto, M.D., M.P.H. Author disclosures are on the abstract.
The American Heart Association funded the study.
Follow news from the ASA International Stroke Conference 2013 via Twitter @HeartNews; #ISC13.
Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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Note: Actual presentation is 4:45 p.m. HT/9:45 p.m. ET Wednesday, Feb. 6, 2013.
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