Risk Factors of Stroke in Pakistan: A Dedicated Stroke Clinic Experience

Abstract

Background: Secondary prevention of cerebrovascular disease through dedicated stroke clinics has been shown to decrease recurrent vascular events in patients. However, there is limited literature describing such stroke clinic experiences from low and middle income countries. This study describes patient characteristics and observations made at the first systematized stroke clinic in Pakistan. Methods: A retrospective audit of medical records of all patients presenting between September 2006 and August 2008 with a cerebrovascular event was conducted. Information about clinical presentation, modifiable risk factors and laboratory and radiological investigations was collected. Burden of disability was assessed using Modified Rankin score. Data was entered and analyzed using SPSS 14.0. Results: 159 patients with a mean age of 57.0 ± 13.9 years were included in this study and 34.6% of all patients were women. 108 patients were diagnosed with ischemic stroke (67.9%) while 34 patients presented with hemorrhagic stroke (21.4%) and 17 patients presented with transient ischemic attacks (10.7%). Hypertension was the most common modifiable risk factor seen in 78.0%, followed by diabetes in 40.3% and dyslipidemia in 31.5%. At presentation to clinic, only 26.0% patients with dyslipidemia and 64.5% patients with hypertension were on appropriate medications. Conclusion: A high prevalence of modifiable risk factors such as hypertension in stroke patients was observed and it presents an opportunity for conventional interventions in Pakistan. Systematized clinics for stroke and an algorithmic approach in primary care towards stroke may improve the implementation of evidence based secondary prevention strategies in developing countries.RÉSUMÉ: Facteurs de risque de l'accident vasculaire cérébral au Pakistan : l'expérience d'une clinique spécialisée. Contexte : Il est bien établi que la prévention secondaire de la maladie cérébrovasculaire dans des cliniques spécialisées en AVC diminue le taux de récidive chez ces patients. Cependant, il y a peu de publications sur ce type de cliniques établies dans des pays à moyen ou à faible revenu. Cette étude décrit les caractéristiques et les observations de patients de la première clinique spécialisée en AVC au Pakistan. Méthodes : Nous avons effectué une revue rétrospective des dossiers médicaux de tous les patients qui ont consulté à la clinique entre septembre 2006 et août 2008 pour un événement cérébrovasculaire. L'information au sujet du tableau clinique, des facteurs de risque modifiables et des examens de laboratoire et de radiologie a été colligée. Le niveau d'invalidité a été évalué au moyen du score à l'échelle de Rankin modifiée. Les données ont été analysées au moyen de SPSS 14.0. Résultats : Cent cinquante-neuf patients, dont l'âge moyen était de 57,0 ± 13,9 ans et dont 34,6% étaient des femmes, ont été inclus dans cette étude. Cent huit patients étaient porteurs d'un AVC ischémique (67,9%), 34 patients étaient porteurs d'un AVC hémorragique (21,4%) et 17 patients avaie...

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