Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study

Abstract

Summary Background Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa. Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs. Findings Between Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59.0 years (SD 13.8) for cases and 57.8 years (13.7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six (<1%) had discrete ischaemic and haemorrhagic lesions. 98.2% (95% CI 97.2–99.0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19.36 (95% CI 12.11–30.93) and 90.8% (95% CI 87.9–93.7) for hypertension, 1.85 (1.44–2.38) and 35.8% (25.3–46.2) for dyslipidaemia, 1.59 (1.19–2.13) and 31.1% (13.3–48.9) for regular meat consumption, 1.48 (1.13–1.94) and 26.5% (12.9–40.2) for elevated waist-to-hip ratio, 2.58 (1.98–3.37) and 22.1% (17.8–26.4) for diabetes, 2.43 (1.81–3.26) and 18.2% (14.1–22.3) for low green leafy vegetable consumption, 1.89 (1.40–2.54) and 11.6% (6.6–16.7) for stress, 2.14 (1.34–3.43) and 5.3% (3.3–7.3) for added salt at the table, 1.65 (1.09–2.49) and 4.3% (0.6–7.9) for cardiac disease, 2.13 (1.12–4.05) and 2.4% (0.7–4.1) for physical inactivity, and 4.42 (1.75–11.16) and 2.3% (1.5–3.1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence. Interpretation Implementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans. Funding National Institutes of Health.

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

“…On a much broader scale, our previous report shows a highly prevalent but poorly controlled hypertension rate in the general population based on evidence gleaned from our HIV-negative sample. 22 This may explain why we found that HIV per se was not to be independently associated with stroke occurrence in a low endemic country such as Ghana, 44 although the burden of stroke and poor outcomes continue to rise in the subregion [45][46][47][48] due to a myriad of factors hampering the control of key CVD risk factors. 49…”

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

“…The number of deaths from stroke in SSA have increased by nearly 50% in past three decades [2,11,68]. Stroke tends to affect the younger productive workforce in SSA compared to the developed world [6], and the mean age at death from stroke in SSA also the lowest among all low-to middle-income countries [2,11,66]. Community-based studies in Africa have revealed age-standardized (to the WHO world population) annual stroke incidence rates of up to 316 per 100,000 population, and age-standardized prevalence rates of up to 981 per 100,000 [67,68].…”

“…A few studies have demonstrated overall positive patient outcomes following acute stroke care interventions in Africa [71]. Given that hypertension is the single most important preventable risk factor for stroke in SSA [6,66], its optimal control should be the main focus to help reduce stroke occurrence.…”

“…Although age-adjusted CVD mortality rates in SSA are low compared to HIC, absolute number of CVD deaths has increased by more than 50% in the past three decades in this region [2] and tend to occur at younger ages, leading to a high number of disability adjusted life years (DALYs) [5][6][7][8][9][10][11][12]. IHD, stroke, and hypertensive heart disease are the three most common causes of CVD death in SSA [2,13].…”

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

“…This observed mortality is somewhat similar to that of 44% and 47% reported ten years ago by Longo-Mbenza et al [20] in the same setting and by Kuate et al [21] at Douala in Cameroon, respectively. However, it is quite higher than that found by most other studies from sub-Saharan African countries [22]- [28]. The differences in the number of deaths between studies and countries could be explained by the differences in public health response against stroke, access to health services, treatment options, population studied, sample size and study design, statistical methods and threshold used to define hyperglycemia [24].…”