Glycemic status may underlies the increased arterial stiffness and impaired endothelial function in South Asian Stroke survivors compared to European Caucasians counterparts in the United Kingdom

Ashan Gunarathne, Jeetesh Patel, Brian Gammon, Razia Butt, Rahul Potluri, Nimai Punjai, Mangala Wijetunge, Julia Chakrabati, Elizabeth Hughes, Greogory Lip
University Department of Medicine, Birmingham, United Kingdom

The pathophysiology of excessive premature cerebrovascular disease mortality amongst South Asian stroke survivors (SA) living in Britain remains unclear.: Indices of arterial stiffness and endothelium dysfunction are accepted as independent markers of cerebrovascular disease having positive prognostic and diagnostic impact We hypothesised that indices of arterial stiffness and endothelial dysfunction are higher in South Asians stroke survivors compared to the European Caucasians.

Using a representative sampling approach (West Midlands, UK) we determined Arterial stiffness (SI) and endothelial dependent vessel function ( post Salbutamol ) & independent (post Glyceryl Tri Nitrate ) administration by digital volume pulse photoplethysmographyi in 60 South Asian stroke survivors and compared to 30 age-gender matched European Caucasians in a temperature controlled environment using a direct, standardised approach.

Both ethnic groups were comparable for cardiovascular risk profiles (Table 1), except higher prevalence of diabetes mellitus in SA (54.1% vs. 10.3%; P<0.001) and atrial fibrillation in EC (17.2% vs. 3.8%; P=0.01). SA had higher arterial stiffness [mean(ms-1)(SD)] (11.06(2.07)vs.9.78(1.36);P=0.008) and impaired endothelial dependent vascular function (%). (3.68(3.0) vs. 6.33(4.1); P=0.007).On univariate analysis fasting plasma glucose was negatively related with endothelial function(R=-0.37; P<0.001) and on multivariate analysis diabetes status (Beta (95%CI)=-3.3(-6.4--0.2);P=0.03) & hypertension (3.7(0.8-6.5);P=0.01) independently associated with endothelial function.

South Asians stroke survivors have an impaired endothelial dependent vascular function and increased arterial stiffness compared to European Caucasians but this appears to explain the disproportional impact of glycemic status and blood pressure on the vascular endothelium and aberrant remodelling of the vessel wall characteristics. Further work is warranted to determine the prognostic implications.