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Home > Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study.

O'Donnell, Martin J and Chin, Siu Lim and Rangarajan, Sumathy and Xavier, Denis and Liu, Lisheng and Zhang, Hongye and Rao-Melacini, Purnima and Zhang, Xiaohe and Pais, Prem and Agapay, Steven and Lopez-Jaramillo, Patricio and Damasceno, Albertino and Langhorne, Peter and McQueen, Matthew J and Rosengren, Annika and Dehghan, Mahshid and Hankey, Graeme J and Dans, Antonio L and Elsayed, Ahmed and Avezum, Alvaro and Mondo, Charles and Diener, Hans-Christoph and Ryglewicz, Danuta and Czlonkowska, Anna and Pogosova, Nana and Weimar, Christian and Iqbal, Romaina and Diaz, Rafael and Yusoff, Khalid and Yusufali, Afzalhussein and Oguz, Aytekin and Wang, Xingyu and Penaherrera, Ernesto and Lanas, Fernando and Ogah, Okechukwu S and Ogunniyi, Adesola and Iversen, Helle K and Malaga, German and Rumboldt, Zvonko and Oveisgharan, Shahram and Al Hussain, Fawaz and Magazi, Daliwonga and Nilanont, Yongchai and Ferguson, John and Pare, Guillaume and Yusuf, Salim (2016) Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet , 388 , (10046) , pp. 761-75.

URL: http://www.sciencedirect.com/science/article/pii/S...

BACKGROUND: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.

METHODS: We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.

FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher, regular physical activity, apolipoprotein (Apo)B/ApoA1 ratio, diet, waist-to-hip ratio, psychosocial factors, current smoking, cardiac causes, alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide, and were consistent across regions sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).

INTERPRETATION: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke.


Item Type
Article
Publication Type
Irish-related, International, Open Access, Article
Drug Type
Alcohol, Tobacco / Nicotine
Intervention Type
Harm reduction
Date
20 August 2016
Page Range
pp. 761-75
Volume
388
Number
10046
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