Dataset Information

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

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.

SUBMITTER: Sarfo FS

PROVIDER: S-EPMC8712357 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

Sarfo Fred S FS Ovbiagele Bruce B Akpa Onoja O Akpalu Albert A Wahab Kolawole K Obiako Reginald R Komolafe Morenikeji M Owolabi Lukman L Ogbole Godwin G Calys-Tagoe Benedict B Fakunle Adekunle A Sanni Taofeek T Mulugeta Gebregziabher G Abdul Salaam S Akintunde Adeseye A AA Olowookere Samuel S Uvere Ezinne O EO Ibinaiye Philip P Akinyemi Joshua J Uwanuruochi Kelechukwu K Olayemi Balogun B Odunlami Olufemi A OA Abunimye Esther E Arulogun Oyedunni O Isah Suleiman Y SY Abubakar Sani A SA Oladimeji Adebayo A Adebayo Philip P Shidali Vincent V Chukwuonye Innocent I II Akpalu Josephine J Tito-Ilori Moyinoluwalogo M MM Asowata Osahon J OJ Sanya Emmanuel O EO Amusa Ganiyu G Onyeonoro Ugochukwu U Ogunmodede James A JA Sule Abdullateef G AG Akisanya Cynthia C Mensah Yaw Y Oyinloye Olalekan I OI Appiah Lambert L Agunloye Atinuke M AM Osaigbovo Godwin O GO Olabinri Eunice E Kolo Philip M PM Okeke Obiora O Adeoye Abiodun M AM Ajose Olabamiji O Jenkins Carolyn C Lackland Daniel T DT Egberongbe Adedeji A AA Adeniji Olaleye O Ohifemen Adeleye Osimhiarherhuo O Tiwari Hemant K HK Arnett Donna D Laryea Ruth Y RY Olunuga Taiwo T Akinwande Kazeem S KS Imoh Lucius L Ogah Okechukwu S OS Melikam Ezinne S ES Adebolaji Adeyemo A Oguike Wisdom W Ogunronbi Olumayowa O Adeniyi Wasiu W Olugbo Obiabo Y OY Bello Abiodun H AH Ohagwu Kenneth A KA Ogunjimi Luqman L Agyekum Francis F Iheonye Henry H Adesina Julius J Diala Samuel S Dambatta Hamisu A HA Ikubor Joyce J Singh Arti A Adamu Sheila S Obese Vida V Adusei Nathaniel N Owusu Dorcas D Ampofo Michael M Tagge Raelle R Efidi Richard R Fawale Bimbo B Yaria Joseph J Akinyemi Rufus R Owolabi Mayowa M

Stroke 20210930 1

<h4>Background and purpose</h4>To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans.<h4>Methods</h4>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 ...[more]

PMID: 34587795

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Project description:BackgroundThere are limited data from Africa on the burden and associations between pre-diabetes (pre-DM), diabetes mellitus (DM) and stroke occurrence in a region experiencing a profound rise in stroke burden.PurposeTo characterize the associations between stroke and dysglycemic status among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with clinical and radiological evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular factors were performed. Pre-diabetes was defined as HBA1c of 5.7%-6.4% or Fasting blood glucose (FBG) 5.6-7.0 mmol/L and DM as HBA1c >6.5% or FBG>7.0 mmol/L. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.ResultsAmong 2,935 stroke cases the mean age was 60.0 ± 14.2 years with 55.2% being males. By glycemic status, 931 (31.7%) were euglycemic, 633 (21.6%) had Pre-diabetes and 1371 (46.7%) had DM. Of the age- and sex-matched stroke-free controls 69.2% were euglycemic, 13.3% had pre-DM and 17.5% had DM. Pre-DM [aOR (95% CI): 3.68(2.61-5.21)] and DM [4.29 (3.19-5.74)] were independently associated with stroke. The aOR of Pre-DM for ischemic stroke 3.06 (2.01-4.64)] was lower than 4.82 (3.37-6.89) for DM. However, the aOR of Pre-DM for hemorrhagic stroke 6.81 (95% CI: 3.29 - 14.08)] was higher than 3.36 (1.94-5.86) for DM. Furthermore, the aOR of pre-DM for ischemic stroke subtypes were 9.64 (1.30-71.57) for cardio-embolic stroke, 3.64 (1.80-7.34) for small-vessel occlusive disease and 4.63 (0.80-26.65) for large-vessel disease.ConclusionPre-DM is strongly and independently associated with stroke in Africans. Improving glycemic control through screening, healthy lifestyle and pharmacotherapy at a population level may be strategic in reducing the rising burden of stroke in Africa.

Project description:BackgroundThe plant-derived omega-3 fatty acid alpha-linolenic acid (ALA) may reduce the risk of cardiovascular disease.ObjectiveWe have investigated associations between the content of ALA in adipose tissue and the risk of ischemic stroke and its subtypes.MethodsIncident cases of ischemic stroke among participants enrolled into the Danish Diet, Cancer and Health cohort (n = 57,053) were identified by linkage with the Danish National Patient Register. Subsequently, all potential cases were validated and classified into ischemic stroke subtypes. The fatty acid composition of adipose tissue was determined by gas chromatography in cases and in a randomly drawn sub-cohort (n = 3500). Statistical analyses were performed using weighted Cox regression.ResultsDuring a median of 13.4 years of follow-up, 1735 cases of total ischemic stroke were identified including 297 cases of large artery atherosclerosis, 772 cases of small-vessel occlusion, 99 cases of cardio-embolism, 91 cases with stroke of other etiology and 476 cases with stroke of undetermined etiology. The median content of ALA in adipose tissue within the sub-cohort was 0.84% (95% central range: 0.53-1.19%). Multivariable analyses showed a U-shaped association between adipose tissue content of ALA and the rate of total ischemic stroke, but this association was not statistically significant (p = 0.172). In analyses of ischemic stroke subtypes, we observed a statistically significant U-shaped association between ALA and the rate of ischemic stroke due to large artery atherosclerosis (p = 0.017), whereas no appreciable association was observed between ALA and the rate of small-vessel occlusion (p = 0.427). A positive but statistically non-significant association was observed between ALA and the rate of ischemic stroke due to cardio-embolism (p = 0.162).ConclusionsThe content of ALA in adipose tissue was statistically non-significantly U-shaped associated with risk of total ischemic stroke. For ischemic stroke subtypes a statistically significant, U-shaped association with large artery atherosclerosis was observed.

Project description:Background and Purpose- Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many stroke causes might be reclassified after accounting for nonstenosing plaques with high-risk features. Methods- We included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of the brain, and magnetic resonance angiography of the neck. High-risk plaque was identified by intraplaque hemorrhage ascertained from routine neck magnetic resonance angiography studies using validated methods. Infarct location was determined from diffusion-weighted imaging. Intraplaque hemorrhage and infarct location were assessed separately in a blinded fashion by a neuroradiologist. We used the McNemar test for matched data to compare the prevalence of intraplaque hemorrhage ipsilateral versus contralateral to brain infarction. We reclassified stroke subtypes by including large-artery atherosclerosis as a cause if there was intraplaque hemorrhage ipsilateral to brain infarction, regardless of the degree of stenosis. Results- Among the 1721 acute ischemic stroke patients registered in the Cornell Acute Stroke Academic Registry from 2011 to 2015, 579 were eligible for this analysis. High-risk plaque was more common ipsilateral versus contralateral to brain infarction in large-artery atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2-6.1]), cryptogenic (RR, 2.1 [95% CI, 1.4-3.1]), and cardioembolic strokes (RR, 1.7 [95% CI, 1.1-2.4]). There were nonsignificant ipsilateral-contralateral differences in high-risk plaque among lacunar strokes (RR, 1.2 [95% CI, 0.4-3.5]) and strokes of other determined cause (RR, 1.5 [95% CI, 0.7-3.3]). After accounting for ipsilateral high-risk plaque, 88 (15.2%) patients were reclassified: 38 (22.6%) cardioembolic to multiple potential etiologies, 6 (8.5%) lacunar to multiple, 3 (15.8%) other determined cause to multiple, and 41 (20.8%) cryptogenic to large-artery atherosclerosis. Conclusions- High-risk carotid plaque was more prevalent ipsilateral to brain infarction across several ischemic stroke subtypes. Accounting for such plaques may reclassify the etiologies of up to 15% of cases in our sample.

Dataset Information

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

Background and purpose

Methods

Results

Conclusions

Publications

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

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