A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study

Akpa, Onoja Matthew; Owolabi, Mayowa; Akpalu, Albert; Wahab, Kolawole; Obiako, Reginald; Komolafe, Morenikeji; Owolabi, Lukman; Osaigbovo, Godwin; Ogbole, GI; Tiwari, Hemant K.; Jenkins, Carolyn; Fakunle, Adekunle; Olowookere, Samuel Anu; Uvere, Ezinne; Akinyemi, Joshua; Arulogun, Oyedunni; Akpalu, Josephine; Tito-Ilori, Moyinoluwalogo M; Asowata, Osahon Jeffery; Ibinaiye, Philip Oluleke; Akisanya, Cynthia; Oyinloye, Olalekan Ibukun; Appiah, Lambert; Sunmonu, Taofik O.; Olowoyo, Paul; Agunloye, Atinuke M; Adeoye, Abiodun M.; Yaria, Joseph; Lackland, Daniel T.; Arnett, Donna K.; Laryea, Ruth; Adigun, Taiwo; Okekunle, Akinkunmi Paul; Calys‐Tagoe, Benedict; Ogah, Okechukwu S; Ogunronbi, Mayowa; Obiabo, Olugbo; Isah, Suleiman Yahaya; Dambatta, Hamisu A; Tagge, Raelle; Ogenyi, Obande; Fawale, Bimbo; Melikam, Chimdinma L.; Onasanya, Akinola; Adeniyi, Sunday; Akinyemi, Rufus; Ovbiagele, Bruce

doi:10.1016/j.jstrokecerebrovasdis.2021.106003

Cited by 8 publications

(11 citation statements)

References 33 publications

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“…The intervals for the scores were created using Studge rule. 32 Group intervals and subsequent performances were examined using a previously outlined step, 30 and probability scores from the training dataset were further classified into 13 groups using an interval of 7.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In the third phase, statistically significant risk factors in the final model were assigned statistical weights derived correspondingly by a linear transformation (necessary to promote the interpretability of the risk assessment model) of the regression coefficient using a method already described elsewhere. 30,31 Constant weighting (β c ) was achieved by rounding up β after multiplying by 10, and a standardized-weighted β coefficient was obtained; βW=β(SxSy) where β w =standardized beta coefficient, β =estimated coefficient, S x =standard deviation (SD) of predictive variable, and S y =SD of the response variable. Hypertensives and normotensives in the training datasets were individually scored using the assigned weight developed in the risk-scoring model.…”

Section: Methodsmentioning

confidence: 99%

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Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study

Asowata,

Okekunle,

Akpa

et al. 2023

Hypertension

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BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m 2 , lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance—receiver operating characteristic: 64% (95% CI, 61.0–68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1–69.3) for the training set and 64.6% (95% CI, 61.0–68.0) for the testing dataset. CONCLUSIONS: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study

Asowata,

Okekunle,

Akpa

et al. 2023

Hypertension

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“…Stroke is the second leading cause of death and the third leading cause of disability-adjusted life years (DALYs) lost worldwide [ 1 , 2 ]. The incidence and mortality of stroke differ between countries, ethnic groups, races, and geographical regions [ 3 ]. Over the past three to four decades, the burden of stroke has reduced in high-income countries (due to improvements in prevention, acute stroke care, and neurorehabilitation) [ 4 , 5 ] but has increased in low- and middle-income countries [ 1 ] with incidence rates in the latter now exceeding those in the former [ 1 , 4 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of performances of SIREN or MFSRS in stroke risk prediction in an African environment

Onwuakagba,

Okoye,

Kanu

et al. 2024

BMC Public Health

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Background The Modified Framingham Stroke Risk Score (MFSRS) is a widely utilized stroke risk assessment algorithm usually applied in international comparison. The Stroke Investigative Research and Educational Network (SIREN) is the only known African-specific stroke risk assessment algorithm. Aims and objectives To compare stroke risk estimates from the SIREN and the MFSRS in an African community. Methods This was a population-based cross-sectional survey involving consecutively recruited 310 consenting adult residents (mean age = 37.21 ± 15.84 years) of a Nigerian community. Risk factors of stroke were assessed among the participants and were utilized in calculating stroke risk estimates on the MFSRS and the SIREN. The obtained data were analyzed using descriptive statistics and the Spearman-rank order correlation test at an alpha level of 0.05. Results The percentage stroke risk scores estimated by the SIREN and the MFSRS were 34.5% and 6.79% respectively. The most prevalent risk factors among the participants were hypertriglyceridemia (100.0%), raised waist-hip ratio (50.6%), hypercholesterolemia (45.5), physical inactivity (43.2%), psychological stress (41.3%), and hypertension (37.7%). Only two (hypertriglyceridemia and high blood pressure) out of the six factors considered in the MFSRS were rated among the first 10 most impactful risks by the SIREN. There was a weak correlation between the total scores on the MFSRS and the SIREN (rho = 0.39; p < 0.01) suggesting that the two ratings were discordant. Conclusion There were disagreements between the risk estimates on the SIREN and MFSRS with SIREN having a higher estimate that corresponded with the literature; this may be suggesting a poorer estimation of stroke risks by the MFSRS in an African environment. There is a need for large African-based quality control studies to determine and address these lapses.

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“…1,2 It has been suggested that effective implementation of population-wide strategies, including motivational digital health technologies can prevent up to 50% to 90% of stroke and cardiovascular disease events world wide. 2 The objective of this pilot randomized controlled trial was to test the feasibility and signal of effect of a mobile health (mHealth) intervention comprising the first-ever Afrocentric stroke risk estimation 3 app and a stroke video in improving stroke risk factor awareness and global risk reduction among stroke-free adults compared with control group.…”

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confidence: 99%

Effect of an Educational Intervention for Primary Stroke Risk Reduction in Ghana and Nigeria: Pilot Randomized Controlled Trial

Sarfo

Akinyemi

Obiako

et al. 2023

Stroke

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BACKGROUND: Using tailored mobile health interventions to improve global vascular risk awareness and control is yet to be investigated for primary stroke prevention in Africa. METHODS: This 2-arm pilot randomized controlled trial involved 100 stroke-free adults with at least 2 vascular risk factors for stroke. Eligible participants were assigned randomly to a control arm offering 1-time counseling (n=50) or a 2-month educational intervention arm (n=50) comprising a stroke video and riskometer app aimed at improving stroke risk factor awareness and health-seeking behavioral modification to control total vascular risk. Reduction in total stroke risk score was the primary outcome while feasibility and process measures were secondary outcomes. RESULTS: All enrolled participants completed the 2-month follow-up (retention rate=100%). The mean (SD) age of participants was 59.5 (±12.5) years, 38% were males. The mean change in stroke risk score at 2 months was −11.9% (±14.2) in the intervention arm versus −1.2% (±9.1) in the control arm, P =0.0001. Stroke risk awareness improved by 16.1% (±24.7) in the intervention arm versus 8.9% (±24.7) in the control arm, P =0.08. The intervention arm had 11.1 mm Hg reduction in systolic blood pressure compared with 4.8 mm Hg reduction in the control arm. CONCLUSIONS: The intervention demonstrated a positive signal of effect over a 2-month period. A definitive clinical trial with a longer duration of follow-up is warranted on the premise of these promising findings from this pilot randomized clinical trial. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05619406.

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A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study

Cited by 8 publications

References 33 publications

Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study

Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study

Comparison of performances of SIREN or MFSRS in stroke risk prediction in an African environment

Effect of an Educational Intervention for Primary Stroke Risk Reduction in Ghana and Nigeria: Pilot Randomized Controlled Trial

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