Key result
Stroke biomarker studies in African-ancestry populations primarily examine CRP and lipids, with ~65% conducted in the US.
Why the study?
Stroke disproportionately affects populations in resource-limited settings including parts of Africa, where blood-based biomarkers may support earlier diagnosis and prognostication. Evidence in African and African diaspora populations needed to be mapped to identify gaps in geographic representation, biomarker coverage, and race-stratified reporting.
This scoping review reveals that blood biomarker research for stroke in African-ancestry populations is heavily skewed toward US cohorts with poor representation from the African continent and inconsistent race-stratified reporting, highlighting an urgent need for African-led cohorts and biomarker discovery.
Answers are grounded in this paper and cite their sources.
Biomarker-guided stroke care should not yet extend to African-descended patients; leaves open generalizability and supports local cohort validation.
Background Stroke is a leading cause of death and disability worldwide, disproportionately affecting populations in resource-limited settings, including parts of Africa. Blood-based biomarkers may complement clinical assessment and neuroimaging to support earlier stroke diagnosis and prognostication. This scoping review mapped evidence in African and African diaspora populations and identified gaps in geographic representation, biomarker coverage, and race-stratified reporting. Methods We followed the Arksey and O'Malley scoping review framework and PRISMA-ScR reporting guidance. With support from a medical librarian, we searched PubMed, Scopus, and WHO Global Index Medicus without date restrictions. Two independent reviewers screened records and full texts, with disagreements resolved by the principal investigator. Results Of the 84 studies, 23 examined only ischemic stroke and 9 examined both ischemic and hemorrhagic subtypes; only 3 focused on hemorrhagic stroke alone, and 49 did not specify subtype. Collectively, the studies examined over 60 distinct blood-based biomarkers, most often C-reactive protein (19 studies), lipids (16 studies), and lipoprotein(a) (12 studies). Fifty-five studies (65%) drew participants from the US, with a single cohort (REGARDS) supplying 22 papers; however, only 11 enrolled participants on the African continent. Additionally, 24 studies (29%) did not present differences in biomarker levels by race. Conclusion Blood biomarker evidence for stroke in African-ancestry populations is concentrated in a small number of U.S. cohorts. The most common biomarkers studied are C-reactive protein, lipids, and lipoprotein(a). African-led cohort studies and consistent race-stratified reporting are needed to build diagnostic tools that work in African settings, which carry a significant stroke burden. Investment in African-led biomarker discovery, biobanks, and longitudinal cohorts has the potential to enable more equitable precision medicine, improving the timely diagnosis and management of stroke for populations that have historically been underrepresented in research.
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Krishnamurthy et al. (2026) conducted a review in Stroke. Blood-based stroke biomarkers (e.g., C-reactive protein, lipids, lipoprotein(a)) was evaluated on Geographic representation, biomarker coverage, and race-stratified reporting across included studies. Blood-based stroke biomarker studies in African-ancestry populations (n=84) mostly evaluated CRP (19), lipids (16), and Lp(a) (12), with 65% from the US and only 11 from Africa.
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