INTERSTROKE study

Read online at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30506-2/abstract
Objective:
To  evaluate variations in common risk factors for stroke by major regions of the world, in key populations (eg, ethnic origin, age, sex), and in subtypes of stroke.

Methods

  • Participants were recruited from 2007-15, from 32 countries (including India) from different parts of world
  • Following factors were evaluated for association with stroke (based on phase I data)
    1. Hypertension
    2. Smoking
    3. Diabetes Mellitus
    4. Lack of guidelines recommended Physical Activity
    5. Diet By mAHEI (modified Alternative Healthy Eating Index) and by lack of fruits and vegetables
    6. Psychosocial Factors
    7. Abdominal Obesity
    8. Alcohol intake
    9. Cardiac Causes (main cause: Atrial Fibrillation),
    10. Apo B/ Apo A Ratio (apolipoproteins)
  •  Population Attributable Risks (PARs) were calculated, with 99% confidence intervals.

Results

  • 26, 919 patients data included; 13 447 cases of acute stroke [< 5 days onset or < 72 hrs of hospitalization, 10,388 with ischaemic stroke & 3059 intracerebral haemorrhage] and 13,472 controls
  • Hypertension was most common cause of stroke. Attributing for 48% of total strokes {PAR : 47.9%},
    • These 10 risk factors accounted for 90·7% of all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage)
  • Hypertension was more associated with intracerebral haemorrhage (Vs ischaemic stroke), whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).
  • Regional Differences

o   Hypertension was significantly associated with all stroke (38·8% in western Europe, North America, Australia to 59·6% in southeast Asia),

o   High ApoB/ApoA1 ratio was significantly associated with ischaemic stroke (24·8% in western Europe, North America, Australia to 67·6% in southeast Asia), and

o   Atrial fibrillation was significantly associated with ischaemic stroke (3·1% in south Asia to 17·1% in western Europe, North America, Australia).

o   Smoking associated with all stroke [4·5% in Africa to 18·0% in western Europe, North America, and Australia.

Conclusion

o   Ten potentially modifiable risk factors are responsible for 90% of strokes in the world.

o   There are important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke.

o   These findings support developing both global and region-specific programmes to prevent stroke.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s