Rationale and Design of INTERSTROKE: A Global Case-Control Study of Risk Factors for Stroke

Abstract

Stroke is a major global health problem. It is the third leading cause of death and the leading cause of adult disability. INTERHEART, a global case-control study of acute myocardial infarction in 52 countries (29,972 participants), identified nine modifiable risk factors that accounted for >90% of population-attributable risk. However, traditional risk factors (e.g. hypertension, cholesterol) appear to exert contrasting risks for stroke compared with coronary heart disease, and the etiology of stroke is far more heterogeneous. In addition, our knowledge of risk factors for stroke in low-income countries is inadequate, where a very large burden of stroke occurs. Accordingly, a similar epidemiological study is required for stroke, to inform effective population-based strategies to reduce the risk of stroke. Methods: INTERSTROKE is an international, multicenter case-control study. Cases are patients with a first stroke within 72 h of hospital presentation in whom CT or MRI is performed. Proxy respondents are used for cases unable to communicate. Etiological and topographical stroke subtype is documented for all cases. Controls are hospital- and community-based, matched for gender, ethnicity and age (±5 years). A questionnaire (cases and controls) is used to acquire information on known and proposed risk factors for stroke. Cardiovascular (e.g. blood pressure) and anthropometric (e.g. waist-to-hip ratio) measurements are obtained at the time of interview. Nonfasting blood samples and random urine samples are obtained from cases and controls. Study Significance: An effective global strategy to reduce the risk of stroke mandates systematic measurement of the contribution of the major vascular risk factors within defined ethnic groups and geographical locations.

Profile and determinants of vascular cognitive impairment in African stroke survivors: The CogFAST Nigeria Study

“…The limited size of the neuroimaging sub-cohort further affected the strength of statistical associations of cognitive outcome in the cohort. Nonetheless, cases with and without neuroimaging were quite similar statistically, and our cohort shares similar demographic and phenomic characteristics with stroke cases described earlier in Nigeria [72] and sub-Saharan Africa [23]. Follow up of our cohort is currently in progress to explore the early evolution of cognitive dysfunction and the determining factors.…”

“…Confirmation of cardiovascular risk factors (hypertension, diabetes mellitus, atrial fibrillation, dyslipidemia, cigarette smoking, and alcohol use) were based on self-report, use of relevant medications and review of medical notes. Lifestyle factors including nutritional status and physical activity were assessed according to the design of the INTERSTROKE Study [23]. Dietary patterns were assessed in all subjects with a food frequency questionnaire assessing the frequency of different types of food taken by the subjects in the prior year before the onset of stroke (and separately in the three months period after stroke) with appropriate addition of common local foods and delicacies to relevant categories.…”

“…Dietary patterns were assessed in all subjects with a food frequency questionnaire assessing the frequency of different types of food taken by the subjects in the prior year before the onset of stroke (and separately in the three months period after stroke) with appropriate addition of common local foods and delicacies to relevant categories. Physical activity was assessed at work and during leisure time and subjects were stratified into sedentary, mild, moderate and heavy physical activity categories [23,24]. All participants were interviewed in the presence of a spouse, family member or caregiver, who had lived with the subject for at least six months in order to validate dietary recall and other historical details provided by the subjects.…”

Increased Brachial-Ankle Pulse Wave Velocity Is Independently Associated with White Matter Hyperintensities

“…Stroke is a major global health problem [1,2] , and white matter hyperintensities (WMHs) are receiving increasing attention as a risk factor for stroke [2][3][4][5][6][7][8][9][10][11] . Furthermore, WMHs are associated with cognitive impairment, silent brain infarction (SBI), cerebral microbleeds, a poor functional outcome after stroke, and mortality [2][3][4][5][6][7][8][9][10][11][12][13][14][15] .…”

Risk factors for myocardial infarction and stroke in Africa

“…The 12 articles considered in this review reported on five separate studies: INTERHEART (8,(11)(12)(13)(14)(15) INTERSTROKE, (16) the WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception (17)(18)(19) and two unnamed studies. (20,21) Only INTER-…”