Drivers of stroke-rate differences and optimal anticoagulant treatment for East Asian ancestry individuals in Western countries

Ascertain the extent to which differences in stroke rates between East Asian and European ancestry populations are attributable to genetic burden versus societal factors, and determine the optimal clinical treatment strategy for individuals of East Asian ancestry living in Western countries in view of elevated risks of intracerebral haemorrhage and bleeding associated with anticoagulant use.

Background

The paper discusses how outcome prevalence and clinical risks can differ across ancestry groups and settings, affecting both power and interpretation in Mendelian randomization and clinical decision-making. Anticoagulants reduce stroke risk by preventing thromboembolism, but East Asian ancestry datasets show higher rates of intracerebral haemorrhage and an elevated bleeding risk when using anticoagulants, which can diminish net benefit.

Because these differences may stem from genetic factors, environmental exposures, health systems, or other social determinants, it is unclear how much each contributes to observed disparities in stroke rates. Consequently, translating findings to clinical recommendations for East Asian ancestry individuals living in Western countries remains unresolved.