Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE) : a case-control study
| Autor: | Hongye Zhang, Fernando Lanas, Prem Pais, Anna Członkowska, Siu Lim Chin, John Ferguson, Xiaohe Zhang, Ahmed Elsayed, Sumathy Rangarajan, Helle K. Iversen, Matthew J. McQueen, Okechukwu S Ogah, Christian Weimar, Steven Agapay, Daliwonga Magazi, Salim Yusuf, Aytekin Oguz, Danuta Ryglewicz, Zvonko Rumboldt, Alvaro Avezum, Patricio Lopez-Jaramillo, Hans-Christoph Diener, Graeme J. Hankey, Peter Langhorne, Xingyu Wang, Germán Málaga, Lisheng Liu, Annika Rosengren, Charles Mondo, Khalid Yusoff, Antonio L. Dans, Shahram Oveisgharan, Afzalhussein Yusufali, Albertino Damasceno, Guillaume Paré, Adesola Ogunniyi, Ernesto Peñaherrera, Purnima Rao-Melacini, Nana Pogosova, Romaina Iqbal, Martin O'Donnell, Denis Xavier, Mahshid Dehghan, Rafael Diaz, Fawaz Al Hussain, Yongchai Nilanont |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Pediatrics International Cooperation Health Behavior Medizin 030204 cardiovascular system & hematology Obesity Abdominal/complications/epidemiology 0302 clinical medicine Waist–hip ratio Risk Factors Epidemiology Odds Ratio Medicine Acute stroke Cerebral Hemorrhage/blood/complications/epidemiology Brain Ischemia/blood/complications/epidemiology Stroke China/epidemiology Cause of death education.field_of_study Evidence-Based Medicine Hypertension/blood/complications/epidemiology General Medicine Middle Aged Diabetes Complications/epidemiology/prevention & control Female Smoking/adverse effects/epidemiology Risk Adult medicine.medical_specialty Apolipoprotein A-I/blood Population Australia/epidemiology Middle East/epidemiology Alcohol Drinking/adverse effects/epidemiology Motor Activity Europe/epidemiology 03 medical and health sciences Stroke/blood/epidemiology/etiology/pathology/prevention & control Diabetes mellitus Humans education Aged Asia/epidemiology business.industry Waist-Hip Ratio Case-control study Atrial Fibrillation/complications/epidemiology Odds ratio Feeding Behavior medicine.disease purl.org/pe-repo/ocde/ford#3.02.00 [https] Apolipoproteins B/blood Africa/epidemiology Case-Control Studies Self Report business Risk Reduction Behavior 030217 neurology & neurosurgery Biomarkers/blood Demography |
| Zdroj: | Repositorio Universidad de Santander Universidad de Santander instacron:Universidad de Santander |
| Popis: | 15 p. 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 (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), 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 (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), 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 |
| Databáze: | OpenAIRE |
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