4.7 Article

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Journal

STROKE
Volume 53, Issue 1, Pages 134-144

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.120.032072

Keywords

atherosclerosis; dyslipidemia; hypertension; ischemic stroke; risk factors

Funding

  1. National Institutes of Health [U54HG007479, R01NS107900, R01NS107900-02S1, R01NS115944-01, 3U24HG009780-03S5, 1R01NS114045-01, 1R13NS11539501A1, D43TW012030]

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This study aimed to identify the qualitative and quantitative contributions of conventional risk factors for the occurrence of ischemic stroke and its subtypes among West Africans. The results showed that hypertension, dyslipidemia, and diabetes were shared risk factors for all subtypes. The occurrence of ischemic stroke in West Africans is associated with traditional vascular risk factors.
Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged >= 18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2 +/- 14.0 versus 60.9 +/- 13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3 +/- 1.5 versus 3.2 +/- 1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

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