Differences in lipid profiles in two Hispanic ischemic stroke populations A. Arauz 1 *, J. G. Romano 2 , A. Ruiz-Franco 1 , T. Shang 2 , C. Dong 2 , T. Rundek 2 , S. Koch 2 , B. Hernández-Curiel 1 , J. Pacheco 1 , P. Rojas 1 , F. Ruiz-Navarro 1 , M. Katsnelson 2 , and R. L. Sacco 2 Background and Purpose The study aims to compare lipid pro- files among ischemic stroke patients in a predominantly Caribbean-Hispanic population in Miami and a Mestizo His- panic population in Mexico City. Methods We analyzed ischemic stroke Hispanic patients with complete baseline fasting lipid profile enrolled contemporane- ously in the prospective registries of two tertiary care teaching hospitals in Mexico City and Miami. Demographic characteris- tics, risk factors, medications, ischemic stroke subtype, and first fasting lipid profile were compared. Vascular risk factor definitions were standardized. Multiple linear regression analysis was performed to compare lipid fractions. Results A total of 324 patients from Mexico and 236 from Miami were analyzed. Mexicans were significantly younger (58·1 vs. 67·4 years), had a lower frequency of hypertension (53·4% vs. 79·7%), and lower body mass index (27 vs. 28·5). There was a trend toward greater prevalence of diabetes in Mexicans (31·5 vs. 24·6%, P = 0·07). Statin use at the time of ischemic stroke was more common in Miami Hispanics (18·6 vs. 9·4%). Mexicans had lower total cholesterol levels (169·9 ± 46·1 vs. 179·9 ± 48·4 mg/dl), lower low-density lipo- protein (92·3 ± 37·1 vs. 108·2 ± 40·8 mg/dl), and higher triglyc- eride levels (166·9 ± 123·9 vs. 149·2 ± 115·2 mg/dl). These differences remained significant after adjusting for age, gender, hypertension, diabetes, body mass index, smoking, ischemic stroke subtype, and statin use. Conclusion We found significant differences in lipid fractions in Hispanic ischemic stroke patients, with lower total choles- terol and low-density lipoprotein, and higher triglyceride levels in Mexicans. These findings highlight the heterogeneity of dyslipidemia among the Hispanic race-ethnic group and may lead to different secondary prevention strategies. Key words: cholesterol, Hispanics, ischemic stroke Introduction Stroke in Hispanics has been described in population-based studies in the United States, showing greater incidence in Hispanics of Caribbean (1) and Mexican-American (2) descent and higher mortality at younger ages (3) when compared with non-Hispanic whites. In addition, stroke subtypes are different in Hispanics (1). Although the association between cholesterol and stroke mor- tality is not as strong as for other vascular events (4,5), accumu- lating evidence has demonstrated a strong association between lipid levels and atherosclerotic disease, including ischemic stroke (IS) (6), and the use of antilipidemic medication has reduced risk of stroke (7) and recurrence of cardiovascular events (8,9). It should be noted that these data come mostly from Caucasian populations. The 2010 US Census reported 50 million Hispanics in the United States, accounting for the largest minority in that country (10); it is estimated that by the year 2050 Hispanics, will constitute 30% of the US population (11). In addition, there are almost 600 million individuals in Latin America and the Caribbean (12). In spite of recent trends suggesting decreasing stroke incidence and mortality, the higher incidence of diabetes, obesity, physical inactivity, and stroke in Hispanics in the United States and Mexico raises significant concerns for increased stroke burden in Hispanics (13). However, very few studies on differences in stroke subtypes and risk factors between Hispanic subgroups have been conducted. In fact, Hispanics are considered as a homogeneous group in epide- miological studies, but they represent a complex and diverse group with differences in race ethnicity; country of origin; accul- turation; cultural, biological, and environmental exposures. In a previous report, we described differences in stroke risk factors between Mexicans and Caribbean Hispanic stroke patients, including greater incidence of low-density lipoprotein in Carib- bean Americans (14). The objective of this study is to further examine the differences in lipid fractions of IS patients across the two different Hispanic populations, a predominantly Caribbean-Hispanics in Miami and a Mestizo Hispanics in Mexico City. Methods We analyzed consecutive Hispanic patients with IS admitted between October 2008 and July 2010 and included in the prospec- tive Stroke Registries of two tertiary care teaching hospitals, the National Institute of Neurology and Neurosurgery (NINN) in Mexico City and Jackson Memorial Hospital/University of Miami Miller School of Medicine in Miami, Florida. The institutional review board at each institution approved the stroke registries. The NINN serves as a referral hospital in Mexico City where most inhabitants are mestizos of mixed European Spanish and Native American heritage. Metropolitan Miami has a diverse population where 64·4% is Hispanic with various countries of origin includ- ing Cuba with 34% of Hispanic population, Colombia 4·6%, Nicaragua 4·5%, and Puerto Rico 4% (15). For this analysis, we included patients from the registries who self-identified as Hispanic, with a clinical diagnosis of IS Correspondence: Antonio Arauz*, Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Insurgentes Sur 3877, Colonia La Fama, México City (DF), CP 14269, México. E-mail: antonio.arauz@prodigy.net.mx, arauzg@prodigy.net.mx 1 Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico 2 Department of Neurology, University of Miami Miller School of Medi- cine, Miami, FL, USA Received: 28 August 2013; Accepted: 29 October 2013; Published online 19 December 2013 Conflict of interest: None declared. DOI: 10.1111/ijs.12239 Research © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization 394 Vol 9, June 2014, 394–399