Background: The relationship of diet with stroke risk among Africans is not well understood. Aim: To investigate the association between dietary patterns and stroke risk among West Africans. Methods: In this multi-centre case-control study, 3684 stroke patients matched (for age and sex) with 3684 healthy controls were recruited from Nigeria and Ghana. Food consumption was assessed using a food frequency questionnaire, and dietary patterns were summarized using principal component analysis. Stroke was defined using predefined criteria primarily on clinical evaluation following standard guidelines. Conditional logistic regression was applied to compute odds ratio (OR) and 95% confidence interval (CI) for stroke risk by tertiles of dietary patterns. Results: Overall, mean age was 59.0±13.9 years, and 3992(54.2%) were males. Seven dietary patterns were identified. Multivariable-adjusted OR (95%CI) for risk of stroke by second and third tertiles (using the lowest (first) tertile as reference) of dietary patterns were; 1.65 (1.43, 1.90) and 1.74 (1.51, 2.02) respectively for ‘poultry product and organ meat’; 1.69 (1.47, 1.96 and, 1.51 (1.31, 1.75) for ‘red meat’; 1.07 (0.92, 1.23) and 1.21 (1.04, 1.40) for ‘fried foods and sweetened drinks’; 0.69 (0.60, 0.80) and 0.45 (0.39, 0.53) for ‘vegetables’; 0.84 (0.72, 0.97) and 0.81 (0.70, 0.93) for ‘whole-grain and fruit drinks’; and 0.97 (0.84, 1.12) and 0.85 (0.73, 0.98) for ‘fruits’ (P<0.05). Conclusions: These data suggest that plant-based diets are associated with a lower risk of stroke and might be a beneficial dietary recommendation for the primary prevention of stroke among Africans.

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Background The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa Aim This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans. Methods We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90mmHg or previous diagnosis or use of antihypertensive medications) from 16,445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) from the SIREN and AWI-Gen studies. Vegetable consumption (in servings/week) was classified as ‘low’ (&lt;6). ‘moderate’ (6-11), ‘sufficient’ (12-29) and ‘high’ (≥30). Odds ratios (OR) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using ‘low’ consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P &lt; 0.05. Results The mean age of participants was 53·0 (+/-10·7) years, and 7,552 (45·9%) were males, while 7,070 (42·9%) had hypertension. Also, 6,672(40·6%) participants had ‘low’ vegetable consumption, and 1,758(10·7%) had ‘high’ vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using ‘low’ consumption as reference), were 1·03 (95% CI: 0·95, 1·12) for ‘moderate’ consumption; 0·80 (0·73, 0·88) for ‘sufficient’ and 0·81 (0·72, 0·92) for ‘high’ consumption, P-for-trend &lt;0·0001. Conclusion Indigenous Africans who consumed at least twelve servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.

Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community‐dwelling stroke‐free population in Ghana and Nigeria. Data for 4267 community‐dwelling stroke‐free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti‐hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p < .05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p < .0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p < .0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p < .0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p < .0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community‐dwelling stroke‐free controls in west Africa. Community‐oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.

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.