What does this research mean for the field?

Black stroke survivors have a higher risk of heart failure and stroke recurrence but lower all-cause mortality compared to White patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This analysis aims to uncover racial disparities in post-stroke outcomes between Black and White patients, focusing on major adverse cardiovascular events.

February 2, 2026

Abstract TP170: Racial Disparities in Post-Stroke Major Adverse Cardiovascular Events (MACE): A Comparative Analysis of Black and White Patients Using Real-World Data

Key Result

Black stroke survivors had a higher risk of heart failure (HR 0.873) and stroke recurrence (HR 0.938) but lower all-cause mortality (HR 1.147) compared to White patients.

Key Points

This analysis aims to uncover racial disparities in post-stroke outcomes between Black and White patients, focusing on major adverse cardiovascular events.
Conducted a retrospective cohort analysis using TriNetX Global Collaborative Network data.
Analyzed 916,976 White and 221,742 Black stroke survivors without major prior health issues.
Utilized propensity score matching to ensure balanced demographics and comorbidities for each cohort.
Assessed outcomes including heart failure, stroke recurrence, and mortality over a 20-year follow-up.
Black stroke survivors showed higher risk of heart failure and stroke recurrence compared to White patients.
Lower all-cause mortality was observed in Black patients after matching.
No significant difference in post-stroke myocardial infarction risk was detected.
Black patients had higher mean stroke recurrence rates and shorter times to recurrence.

Structured PICO

Does Black race compared to White race affect the risk of MACE and mortality in adult stroke survivors?

Population

Adult stroke survivors (ischemic and hemorrhagic) without prior myocardial infarction (MI), heart failure, or cancer (n=442,886 matched; 221,443 Black and 221,443 White patients).

Intervention

Black race

Comparator

White race

Outcome

Major adverse cardiovascular events (MACE) and mortality, specifically including MI, heart failure, stroke recurrence, and death over a 20-year follow-uphard clinical

Black stroke survivors face higher risks of stroke recurrence and heart failure but lower all-cause mortality compared to White stroke survivors over a 20-year follow-up.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Racial disparities in post-stroke (ischemic and hemorrhagic) outcomes remain a critical public health concern. This study compared the risk of major adverse cardiovascular events (MACE) and mortality between Black and White stroke survivors using a large-scale electronic health records database. Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network, comprising 154 healthcare organizations. We identified 916,976 White (Cohort A) and 221,742 Black (Cohort B) adult stroke survivors without prior myocardial infarction (MI), heart failure, or cancer. Propensity score matching (1:1) balanced baseline demographics and comorbidities, yielding 221,443 patients per cohort. Outcomes assessed included MI, heart failure, stroke recurrence, and death, analyzed via risk differences, survival analysis, and incidence rates over a 20-year follow-up. Results: After matching, Black stroke survivors had a higher risk of heart failure (Risk Difference RD -0.006, p<0.001; Hazard Ratio HR 0.873, 95% CI 0.852–0.895) and stroke recurrence (RD -0.019, p<0.001; HR 0.938, 95% CI 0.928–0.947) but lower all-cause mortality (HR 1.147, 95% CI 1.126–1.169) compared to White patients. No significant difference was observed in post-stroke MI risk (RD 0.000, p=0.367). Black patients also experienced higher stroke recurrence rates (mean 6.66 vs. 5.73 events, p<0.001) and shorter median time to recurrence (1,984 vs. 3,024 days). Conclusion: Racial disparities persist in post-stroke outcomes, with Black patients facing elevated risks of stroke recurrence and heart failure but lower mortality. These findings underscore the need for targeted interventions to address inequities in post-stroke care and secondary prevention.