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: Hemorrhagic Ischemic

Classification of Stroke (CVA)  Hemorrhagic Intracerebral Hemorrhage Subarachnoid Hemorrhage  Ischemic Transient Ischemic Attack Thrombotic Stroke Embolic Stroke Systemic 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: Demographics Risk factors Presentation Roles of underlying conditions Rankin 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% Aboriginal 1% Asian 2% Caribbean 19% Caucasian 1% East Indian 2% Hispanic 1% Pacific Islander 4% other

Results  Mean age of stroke: Aboriginal males: yrs Males in other population: yrs Aboriginal females: yrs Females in other population: yrs  Mean age of stroke in both males and females: Aboriginal population: yrs Other population: 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: Smoking Binge Drinking

Conclusions  Significant contributors to stroke: Diabetes Hypertension Hyperlipidemia  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