Specificities of Ischemic Stroke Risk Factors in Arab-Speaking Countries

Abstract

Background: Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries. Summary: We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (n = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both p ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; p = 0.07). Key Messages: Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.

Risk Factors for Ischaemic Stroke in an Omani Community

“…The large, multinational OPTIC registry and PERFORM trial observed a trend of higher frequency of conventional risk factors for stroke, as well as inadequately managed diabetes mellitus, hypertension, and tobacco smoking in patients from Arab countries. 15 Though the significantly higher prevalence of diabetes mellitus among IS cases was noted in our study, diabetes mellitus and smoking were not found to be important risk factors on logistic regression analysis. Earlier studies have observed a younger age of occurrence of stroke in Arab countries.…”

“…Earlier studies have observed a younger age of occurrence of stroke in Arab countries. 15 While 89% of the cases in the present study were in the age group above 45 years, the mean age of IS patients is at least a decade less than that reported in Western populations. A larger study may be required to provide a plausible explanation for these findings related to diabetes, smoking and older age in our cases in our study.…”

“…The analyses were carried out using Statistical Package for the Social Sciences (SPSS), Version 23 (IBM Corp., Armonk, New York, USA). 14 A P value of <0.05 (2-tailed tests) was considered statistically significant.…”

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

“…In men, MACEs occurred early: in the first year, the number of events was 87 (65.4%) and in the second year, 35 (26.3%) compared to 5 (3.7%) in the third, 3 (2.2%) in the fourth, and 3 (2.2%) in the fifth year. In women also, MACEs occurred predominantly in the first (63, 54.7%), second (28, 24.3%), and third (19,16.5%) years compared to the fourth (4, 3.4%) and fifth (1, 0.9%) years (Fig. 1).…”

“…The reasons for these sexual difference may include decreased understanding of stroke in women [10], increase in incidence and poor management of risk factors [5,11], delays in admission to hospital [12], altered symptomatology leading to missing the diagnosis or delay in diagnosis [12,13], fewer investigations during the acute admission [13], less specialized care following admission [14], higher frequency of complications, and biological difference in endothelial and other functions in the 2 sexes [15]. Although a few studies from the Middle East have reported on the sexual differences in the risk factor profile [16], clinical presentation, and outcome of stroke [17], to our knowledge, there is no study reporting specifically on the effect of sexual difference in major adverse cardiovascular events (MACEs). We have previously reported on the risk factors, clinical presentation, and outcome following AS in a diverse group of patients in Qatar [18][19][20][21].…”