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.

TNF-α (G-308A) Polymorphism, Circulating Levels of TNF-α and IGF-1: Risk Factors for Ischemic Stroke—An Updated Meta-Analysis

“…As it has been mentioned except for other risk factors, age and sex may also involve in the etiology of different stroke subtypes ( Moond et al, 2020 ; Tang et al, 2020 ). Thus, in future studies, we will consider stroke severity, subtype, hypertension, dyslipidemia, diabetes, and psychosocial stress in the etiology of IS ( Sarfo et al, 2022 ).…”

Behavioural and nutritional risk factors for cardiovascular diseases among the Ghanaian population- a cross-sectional study

“…In Ghana, ASCVDs are common and mainly driven by strokes [ 3 – 5 ] and coronary artery disease which contributes significantly to the burden of heart failure [ 6 – 8 ]. Several risk factors have been identified in previous studies contributing to the high burden of stroke and other ASCVDs in Ghana and Nigeria including hypertension, dyslipidaemia, regular meat intake, central obesity, cigarette smoking, and diabetes mellitus [ 9 , 10 ]. Others include inadequate fruit and vegetable intake, physical inactivity, and psychosocial stress.…”

A potential relationship between MMP-9 rs2250889 and ischemic stroke susceptibility

“…Although the pathogenesis of IS still has been debated, more and more studies have highlighted that the pathogenesis of IS is regulated by multiple factors, such as smoking, hypertension, diabetes, drinking, and age ( 4 ). Recently, a report of Mendelian randomization has identified supported atrial fibrillation (AF), body mass index (BMI), smoking, blood pressure, white matter hyperintensity, and type 2 diabetes mellitus (T2DM) as risk factors of IS ( 5 ). In addition, many studies have emphasized the influence of genetic factors on IS, and exactly, single nucleotide polymorphisms (SNPs) in gene have a certain regulatory effect on the occurrence of IS ( 4 , 6 ).…”