Risk Factor Characterization of Ischemic Stroke Subtypes among West Africans
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Date
2022
Authors
Sarfo, F.S.,
Ovbiagele, B.,
Akpa, O.M.
Akpalu, A., Wahab, K.W., Obiakpo, R.,
Ogunmodede, James Ayodele
Sule, A.G.
et al
Journal Title
Journal ISSN
Volume Title
Publisher
American Heart Association
Abstract
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 cardiometabolic 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.
Description
Keywords
Key Words: atherosclerosis ◼ dyslipidemia ◼ hypertension ◼ ischemic stroke ◼ risk factors
Citation
Stroke 53(1):134-44