ORIGINAL RESEARCH article
Front. Stroke
Sec. Population Health and Risk Factors of Stroke
Ethnic differences in cerebral atherosclerotic burden between Arabs and Jews living in Israel
Provisionally accepted
- 1Bar Ilan University Faculty of Medicine, Zafed, Israel
- 2Interventional Neuroradiology, Galilee Medical Center, Nahariya, Israel
- 3Stroke Unit, Galilee Medical Center, Nahariya, Israel
- 4Neurosurgery, Galilee Medical Center, Nahariya, Israel
- 5Medicine, Galilee Medical Center, Nahariya, Israel
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Background: Studies have demonstrated that the prevalence and severity of internal carotid atherosclerotic stenosis (ICAS) vary between ethnic groups. However, Arabs have been largely neglected despite their significant worldwide representation, especially in Europe. The purpose of the present study was to explore the differences in the cerebrovascular atherosclerotic burden between Arab and Jewish populations in Israel. Methods: Two hundred patients electively admitted for treatment of ICAS by internal carotid artery stenting were included. Demographics, medical status, hospital and community practice recordings were prospectively collected. All patients had a four-vessels digital subtraction angiography with diameter assessment of each extracranial and intracranial artery A cerebral atherosclerotic burden score was defined both intra (iCAB) and extracranially (eCAB) as the sum of all extra and intracranial arteries stenosis. Results: There was no difference between Arab and Jews, neither in age, sex and body mass index, nor in any of all investigated risk factors. However, differences in atherosclerotic burden scores between Arabs and Jews were statistically significant both in unadjusted non-parametric tests and after adjustment for major vascular risk factors including age, sex, body mass index (BMI), smoking status, diabetes mellitus, hypertension, atrial fibrillation, and hyperlipidemia. The effect of ethnicity remained robust across all Poisson regression models, with Arab ethnicity associated with substantially increased atherosclerotic burden. Conclusions: Our findings suggest that ethnicity, likely acting as a surrogate for a combination of genetic, environmental, socioeconomic, and healthcare access factors, plays an independent role in determining the extent of cerebral vascular disease in this high-risk population.
Keywords: Stroke, Internal Carotid Artery Stenosis, Atherosclerosis, ethnicity, Epidemiology - analytic (risk factors)
Received: 13 Sep 2025; Accepted: 14 Jan 2026.
Copyright: © 2026 Jahshan, Kiegler, Salamy, Barhoum and Soustiel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jean Francois Soustiel
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