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RISK FACTORS FOR ISCHAEMIC AND INTRACEREBRAL HAEMORRHAGIC STROKE IN 22 COUNTRIES (THE INTERSTROKE STUDY): A CASE-CONTROL STUDY

Published on Jul 1, 2010in The Lancet59.10
· DOI :10.1016/S0140-6736(10)60834-3
Martin O'Donnell50
Estimated H-index: 50
(National University of Ireland, Galway),
Denis Xavier46
Estimated H-index: 46
(St. John's Medical College)
+ 21 AuthorsSalim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute)
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Abstract
Summary Background The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction. Methods We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days of symptoms onset and 72 h of hospital admission). Controls had no history of stroke, and were matched with cases for age and sex. All participants completed a structured questionnaire and a physical examination, and most provided blood and urine samples. We calculated odds ratios (ORs) and population-attributable risks (PARs) for the association of all stroke, ischaemic stroke, and intracerebral haemorrhagic stroke with selected risk factors. Findings In the first 3000 cases (n=2337, 78%, with ischaemic stroke; n=663, 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all stroke were: history of hypertension (OR 2·64, 99% CI 2·26–3·08; PAR 34·6%, 99% CI 30·4–39·1); current smoking (2·09, 1·75–2·51; 18·9%, 15·3–23·1); waist-to-hip ratio (1·65, 1·36–1·99 for highest vs lowest tertile; 26·5%, 18·8–36·0); diet risk score (1·35, 1·11–1·64 for highest vs lowest tertile; 18·8%, 11·2–29·7); regular physical activity (0·69, 0·53–0·90; 28·5%, 14·5–48·5); diabetes mellitus (1·36, 1·10–1·68; 5·0%, 2·6–9·5); alcohol intake (1·51, 1·18–1·92 for more than 30 drinks per month or binge drinking; 3·8%, 0·9–14·4); psychosocial stress (1·30, 1·06–1·60; 4·6%, 2·1–9·6) and depression (1·35, 1·10–1·66; 5·2%, 2·7–9·8); cardiac causes (2·38, 1·77–3·20; 6·7%, 4·8–9·1); and ratio of apolipoproteins B to A1 (1·89, 1·49–2·40 for highest vs lowest tertile; 24·9%, 15·7–37·1). Collectively, these risk factors accounted for 88·1% (99% CI 82·3–92·2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90·3% (85·3–93·7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke. Interpretation Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, and Boehringer Ingelheim.
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  • References (40)
  • Citations (1601)
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References40
Newest
Published on Feb 18, 2010in The New England Journal of Medicine70.67
Lawrence J. Appel101
Estimated H-index: 101
,
Cheryl A.M. Anderson39
Estimated H-index: 39
(Johns Hopkins University)
Health care reform remains a point of focus on the U.S. political agenda. Actively debated are fundamental changes to the health care delivery system, which largely focuses on the diagnosis and treatment of existing disease. Prevention of disease, commonly accomplished through public health interventions, appears to be an afterthought, perhaps because the benefits are mistakenly perceived as small and the cost savings delayed. In this issue of the Journal, Bibbins-Domingo and colleagues1 documen...
Published on Feb 1, 2010in Lancet Neurology28.75
Geoffrey A. Donnan96
Estimated H-index: 96
,
Graeme J. Hankey102
Estimated H-index: 102
(RPH: Royal Perth Hospital),
Stephen M. Davis Mpa Msw89
Estimated H-index: 89
(Royal Melbourne Hospital)
Published on Jan 1, 2010in Neuroepidemiology2.69
Martin O'Donnell50
Estimated H-index: 50
(McMaster University),
Denis Xavier46
Estimated H-index: 46
(St. John's University)
+ 24 AuthorsSumathy Rangarajan10
Estimated H-index: 10
(McMaster University)
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
Published on Dec 1, 2009in Journal of the American College of Cardiology18.64
Ralph L. Sacco123
Estimated H-index: 123
(UM: University of Miami),
Minesh Khatri9
Estimated H-index: 9
(Columbia University)
+ 7 AuthorsMyunghee C. Paik55
Estimated H-index: 55
(Columbia University)
Objectives This study sought to improve global vascular risk prediction with behavioral and anthropometric factors. Background Few cardiovascular risk models are designed to predict the global vascular risk of myocardial infarction, stroke, or vascular death in multiethnic individuals, and existing schemes do not fully include behavioral risk factors. Methods A randomly derived, population-based, prospective cohort of 2,737 community participants free of stroke and coronary artery disease was fo...
Published on Nov 11, 2009in JAMA51.27
Emanuele Di Angelantonio54
Estimated H-index: 54
,
Nadeem Sarwar29
Estimated H-index: 29
+ 10 AuthorsJohn Danesh101
Estimated H-index: 101
CONTEXT: Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified. OBJECTIVE: To assess major lipids and apolipoproteins in vascular risk. DESIGN, SETTING, AND PARTICIPANTS: Individual records were supplied on 302,430 people without initial vascular disease from 68 long-term prospective studies, mostly in Europe and North America. During 2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions, 3928 corona...
Published on Apr 18, 2009in The Lancet59.10
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
Summary Background The combination of three blood-pressure-lowering drugs at low doses, with a statin, aspirin, and folic acid (the polypill), could reduce cardiovascular events by more than 80% in healthy individuals. W e examined the eff ect of the Polycap on blood pressure, lipids, heart rate, and urinary thromboxane B2, and assessed its tolerability. Methods In a double-blind trial in 50 centres in India, 2053 individuals without cardiovascular disease, aged 45–80 years, and with one risk fa...
Published on Apr 1, 2009in Lancet Neurology28.75
Martin O'Donnell6
Estimated H-index: 6
(Population Health Research Institute),
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute)
To be eff ective, global and regional strategies to reduce the incidence and prevalence of stroke require an understanding of the frequency and determinants of stroke in diverse geographical locations and diff erent ethnic groups. In this issue of The Lancet Neurology, Feigin and co-workers and Johnston and co-workers present important and related epidemiological observations on global stroke incidence. Feigin and co-workers report on the divergence in stroke incidence between low to middle inco...
Published on Apr 1, 2009in Lancet Neurology28.75
S. Claiborne Johnston80
Estimated H-index: 80
(UCSF: University of California, San Francisco),
Shanthi Mendis36
Estimated H-index: 36
(WHO: World Health Organization),
Colin Mathers79
Estimated H-index: 79
(WHO: World Health Organization)
Summary Background Recent improvements in the monitoring and modelling of stroke have led to more reliable estimates of stroke mortality and burden worldwide. However, little is known about the global distribution of stroke and its relations to the prevalence of cardiovascular disease risk factors and sociodemographic and economic characteristics. Methods National estimates of stroke mortality and burden (measured in disability-adjusted life years [DALYs]) were calculated from monitoring vital s...
Published on Mar 3, 2009in Circulation23.05
Teresa T. Fung42
Estimated H-index: 42
,
Kathryn M. Rexrode72
Estimated H-index: 72
+ 3 AuthorsFrank B. Hu202
Estimated H-index: 202
Background— Several studies have documented an inverse association between adherence to the Mediterranean diet and risk of coronary heart disease (CHD), but few data are available on the relationship between Mediterranean diet and risk of stroke. Methods and Results— For the present study, 74 886 women 38 to 63 years of age in the Nurses’ Health Study, a cohort study of female nurses, without a history of cardiovascular disease and diabetes were followed up from 1984 to 2004. We computed an Alte...
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AlJohara M. AlQuaiz5
Estimated H-index: 5
(KSU: King Saud University),
Amna Rehana Siddiqui13
Estimated H-index: 13
(KSU: King Saud University)
+ 2 AuthorsAli M. Al-Hazmi3
Estimated H-index: 3
(KSU: King Saud University)
Background Studies from Saudi Arabia have reported a continued increase in the prevalence of cardiovascular diseases and their associated risk factors. The objective of this study was to measure the gender differences in the cardiovascular disease (CVD) risk based on Framingham risk scores (FRS) and to explore the association of FRS with sedentary life style including physical inactivity, sitting time and central obesity among Saudi adults.
Published on Dec 1, 2019in Journal of Headache and Pain3.92
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Estimated H-index: 15
(Hacettepe University),
Katharina Eikermann-Haerter21
Estimated H-index: 21
(Harvard University)
Background Population-based studies have highlighted a close relationship between migraine and stroke. Migraine, especially with aura, is a risk factor for both ischemic and hemorrhagic stroke. Interestingly, stroke risk is highest for migraineurs who are young and otherwise healthy.
Published on Feb 4, 2019in Scientific Reports4.01
Guohua Zheng3
Estimated H-index: 3
(FJUTCM: Fujian University of Traditional Chinese Medicine),
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Estimated H-index: 1
(SHU: Shanghai University)
+ 3 AuthorsLidian Chen20
Estimated H-index: 20
(FJUTCM: Fujian University of Traditional Chinese Medicine)
The aim of current study was to assess the effects of Baduanjin exercise on cerebrovascular function, cardiac structure and cardiac function, static pulmonary function, traditional risk factors of CVD and the related psychological outcomes in older community adults at risk for ischaemic stroke. A randomized controlled trial was conducted in three community between November 2013 and October 2015. Older community-dwelling adults (N = 170) were randomly allocated into either a Baduanjin training (5...
Published on Feb 4, 2019in BMC Geriatrics2.82
Karin Modig10
Estimated H-index: 10
(KI: Karolinska Institutet),
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Estimated H-index: 20
(KI: Karolinska Institutet)
+ 1 AuthorsAnders Ahlbom77
Estimated H-index: 77
(KI: Karolinska Institutet)
Background Stroke incidence has declined during the past decades. Yet, there is a concern that an ageing population together with improved survival after stroke will result in a raised proportion of the population who have experienced a stroke, as well as increasing incidence rate of recurrent strokes, and, absolute numbers of strokes. The objectives of this study were to investigate how the age specific incidence rates of recurrent strokes have developed in relation to the incidence rates of fi...
Published on Jan 8, 2019in BMC Cardiovascular Disorders1.95
Pablo Miranda-Machado , Fernando Salcedo-Mejía + 3 AuthorsNelson Alvis35
Estimated H-index: 35
(University of Cartagena)
Background According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous card...
Published on Sep 1, 2019in Brain Research2.93
Abstract Most intracerebral hemorrhage (ICH) survivors have poor long-term outcomes, such as cognitive deficits and depression. Delayed lesions of ICH include neuron loss and white matter injury and the pathology of the lesions involves iron deposition and glial responses, which contribute to depressive-like behavior and cognitive impairment in animals. This study aimed to investigate the effects of FTY720 (0.3 mg/kg/day for 4 weeks) on iron deposition, glial responses, histological abnormalitie...
Published on May 2, 2019in Neurological Sciences2.48
Brice Blum3
Estimated H-index: 3
(USC: University of South Carolina),
Alexandria Penwell1
Estimated H-index: 1
(USC: University of South Carolina)
+ 3 AuthorsThomas I. Nathaniel10
Estimated H-index: 10
(USC: University of South Carolina)
Objective To investigate clinical risk factors that were associated with gender differences in thrombolysis therapy in stroke patients with incidence of obesity.
Published on May 4, 2019in Neurological Sciences2.48
Sara Gasparini12
Estimated H-index: 12
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Edoardo Ferlazzo21
Estimated H-index: 21
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+ 25 AuthorsPaolo Benna14
Estimated H-index: 14
Background Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy.
Published on Jul 1, 2019in Journal of Stroke & Cerebrovascular Diseases1.65
Hala A. Shaheen1
Estimated H-index: 1
(FU: Fayoum University),
Wafaa Y. Abdel Wahed3
Estimated H-index: 3
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Abstract Background: Stroke is a highly prevalent disease with consequent mortality and morbidity. Few community based studies have been conducted only in upper Egypt to estimate prevalence of stroke. Objectives: This study was designed to find out the prevalence of stroke in Fayoum Governorate & to study some associated risk factors. Methods: through this community based cross-sectional study 4784 participants aged more than or equal to 18 years old were enrolled. A multi-stage random sample te...
Published in Journal of Neurology4.20
Huan Cai4
Estimated H-index: 4
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Biyang Cai5
Estimated H-index: 5
(NU: Nanjing University)
+ -3 AuthorsJialin Liang
Background and purpose Although observational studies have reported a positive association between depression and ischemic stroke, causality remains inconclusive. We aimed to assess the causal relationship of major depressive disorder (MDD) with ischemic stroke, especially with the small vessel stroke (SVS) subtype.