학술논문
Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans
Document Type
Academic Journal
Author
Sarfo, Fred S.; Ovbiagele, Bruce; Akpa, Onoja; Akpalu, Albert; Wahab, Kolawole; Obiako, Reginald; Komolafe, Morenikeji; Owolabi, Lukman; Ogbole, Godwin; Calys-Tagoe, Benedict; Fakunle, Adekunle; Sanni, Taofeek; Mulugeta, Gebregziabher; Abdul, Salaam; Akintunde, Adeseye A.; Olowookere, Samuel; Uvere, Ezinne O.; Ibinaiye, Philip; Akinyemi, Joshua; Uwanuruochi, Kelechukwu; Olayemi, Balogun; Odunlami, Olufemi A.; Abunimye, Esther; Arulogun, Oyedunni; Isah, Suleiman Y.; Abubakar, Sani A.; Oladimeji, Adebayo; Adebayo, Philip; Shidali, Vincent; Chukwuonye, Innocent I.; Akpalu, Josephine; Tito-Ilori, Moyinoluwalogo M.; Asowata, Osahon J.; Sanya, Emmanuel O.; Amusa, Ganiyu; Onyeonoro, Ugochukwu; Ogunmodede, James A.; Sule, Abdullateef G.; Akisanya, Cynthia; Mensah, Yaw; Oyinloye, Olalekan I.; Appiah, Lambert; Agunloye, Atinuke M.; Osaigbovo, Godwin O.; Olabinri, Eunice; Kolo, Philip M.; Okeke, Obiora; Adeoye, Abiodun M.; Ajose, Olabamiji; Jenkins, Carolyn; Lackland, Daniel T.; Egberongbe, Adedeji A.; Adeniji, Olaleye; Ohifemen Adeleye, Osimhiarherhuo; Tiwari, Hemant K.; Arnett, Donna; Laryea, Ruth Y.; Olunuga, Taiwo; Akinwande, Kazeem S.; Imoh, Lucius; Ogah, Okechukwu S.; Melikam, Ezinne S.; Adebolaji, Adeyemo; Oguike, Wisdom; Ogunronbi, Olumayowa; Adeniyi, Wasiu; Olugbo, Obiabo Y.; Bello, Abiodun H.; Ohagwu, Kenneth A.; Ogunjimi, Luqman; Agyekum, Francis; Iheonye, Henry; Adesina, Julius; Diala, Samuel; Dambatta, Hamisu A.; Ikubor, Joyce; Singh, Arti; Adamu, Sheila; Obese, Vida; Adusei, Nathaniel; Owusu, Dorcas; Ampofo, Michael; Tagge, Raelle; Efidi, Richard; Fawale, Bimbo; Yaria, Joseph; Akinyemi, Rufus; Owolabi, Mayowa
Source
Stroke. Sep 30, 2021
Subject
Language
English
ISSN
0039-2499
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 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.