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Stroke ; 53(1): 134-144, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34587795

RESUMEN

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.


Asunto(s)
Accidente Cerebrovascular Isquémico/etnología , Accidente Cerebrovascular Isquémico/fisiopatología , África Occidental/etnología , Anciano , Estudios de Casos y Controles , Diabetes Mellitus/etnología , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/prevención & control , Dislipidemias/etnología , Dislipidemias/fisiopatología , Dislipidemias/prevención & control , Femenino , Ghana/etnología , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Hipertensión/prevención & control , Accidente Cerebrovascular Isquémico/prevención & control , Masculino , Persona de Mediana Edad , Nigeria/etnología , Obesidad/etnología , Obesidad/fisiopatología , Obesidad/prevención & control , Factores de Riesgo
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