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Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

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dc.contributor.author O'Donnell, Martin-J.
dc.contributor.author Chin, Siu-Lim
dc.contributor.author Rangarajan, Sumathy
dc.contributor.author Xavier, Denis
dc.contributor.author Liu, Lisheng
dc.contributor.author Zhang, Hongye
dc.contributor.author Rao-Melacini, Purnima
dc.contributor.author Zhang, Xiaohe
dc.contributor.author Pais, Prem
dc.contributor.author Agapay, Steven
dc.contributor.author Lopez-Jaramillo, Patricio
dc.contributor.author Damasceno, Albertino
dc.contributor.author Langhorne, Peter
dc.contributor.author McQueen, Matthew-J.
dc.contributor.author Rosengren, Annika
dc.contributor.author Dehghan, Mahshid
dc.contributor.author Hankey, Graeme-J.
dc.contributor.author Dans, Antonio-L.
dc.contributor.author Elsayed, Ahmed
dc.contributor.author Avezum, Alvaro
dc.contributor.author Mondo, Charles
dc.contributor.author Diener, Hans-Christoph
dc.contributor.author Ryglewicz, Danuta
dc.contributor.author Czlonkowska, Anna
dc.contributor.author Pogosova, Nana
dc.contributor.author Weimar, Christian
dc.contributor.author Iqbal, Romaina
dc.contributor.author Diaz, Rafael
dc.contributor.author Yusoff, Khalid
dc.contributor.author Yusufali, Afzalhussein
dc.contributor.author Oguz, Aytekin
dc.contributor.author Wang, Xingyu
dc.contributor.author Penaherrera, Ernesto
dc.contributor.author Lanas, Fernando
dc.contributor.author Ogah, Okechukwu-S.
dc.contributor.author Ogunniyi, Adesola
dc.contributor.author Iversen, Helle-K.
dc.contributor.author Malaga, German
dc.contributor.author Rumboldt, Zvonko
dc.contributor.author Oveisgharan, Shahram
dc.contributor.author Al-Hussain, Fawaz
dc.contributor.author Magazi, Daliwonga
dc.contributor.author Nilanont, Yongchai
dc.contributor.author Ferguson, John
dc.contributor.author Pare, Guillaume
dc.contributor.author Yusuf, Salim
dc.date.accessioned 2019-02-06T14:45:56Z
dc.date.available 2019-02-06T14:45:56Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5129
dc.description.abstract 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<0.0001). INTERPRETATION: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found 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. Our findings support developing both global and region-specific programmes to prevent stroke. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1474-547X
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Risk Reduction Behavior en_US
dc.subject Adult en_US
dc.subject Africa/epidemiology en_US
dc.subject Aged en_US
dc.subject Alcohol Drinking/adverse effects/epidemiology en_US
dc.subject Apolipoprotein A-I/blood en_US
dc.subject Apolipoproteins B/blood en_US
dc.subject Asia/epidemiology en_US
dc.subject Atrial Fibrillation/complications/epidemiology en_US
dc.subject Australia/epidemiology en_US
dc.subject Biomarkers/blood en_US
dc.subject Brain Ischemia/blood/complications/epidemiology en_US
dc.subject Case-Control Studies en_US
dc.subject Cerebral Hemorrhage/blood/complications/epidemiology en_US
dc.subject China/epidemiology en_US
dc.subject Diabetes Complications/epidemiology/prevention & control en_US
dc.subject Europe/epidemiology en_US
dc.subject Evidence-Based Medicine en_US
dc.subject Feeding Behavior en_US
dc.subject Female en_US
dc.subject Health Behavior en_US
dc.subject Humans en_US
dc.subject Hypertension/blood/complications/epidemiology en_US
dc.subject International Cooperation en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Middle East/epidemiology en_US
dc.subject Motor Activity en_US
dc.subject Obesity, Abdominal/complications/epidemiology en_US
dc.subject Odds Ratio en_US
dc.subject Risk Factors en_US
dc.subject Self Report en_US
dc.subject Smoking/adverse effects/epidemiology en_US
dc.subject Stroke/blood/epidemiology/etiology/pathology/prevention & control en_US
dc.subject Waist-Hip Ratio en_US
dc.title Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(16)30506-2
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00


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