Ten Risk Factors Key to Global Stroke Risk

By Worcester, Sharon | Clinical Psychiatry News, November 2010 | Go to article overview

Ten Risk Factors Key to Global Stroke Risk


Worcester, Sharon, Clinical Psychiatry News


Ten distinct risk factors account for about 90% of global stroke risk, according to findings from the first phase of INTERSTROKE, a multinational, case-control study that has enrolled 6,000 patients and controls thus far.

The findings, which suggest that the stroke burden could be substantially reduced by targeted interventions to address the identified risk factors, were published online in the Lancet, and were reported simultaneously at the World Congress of Cardiology in Beijing.

Five of the risk factors that were found to be significantly associated with stroke risk accounted for about 80% of the population-attributable risk for all stroke; these were self-reported hypertension, current smoking, abdominal obesity (highest vs. lowest fertile of waist:hip ratio), diet (highest vs. lowest diet risk score), and regular physical activity. These comparisons yielded odds ratios of 2.64, 2.09, 1.65, 1.35, and 0.69, respectively.

The addition of another five significant risk factors that were identified in this study further increased the population-attributable risk for all stroke associated with these risk factors to 90%. These additional risk factors (diabetes, alcohol intake of more than 30 drinks per month/binge drinking, psychosocial stress/depression, cardiac causes, and highest vs. lowest tertile of the ratio of apolipoproteins B to A1) generally increased the odds of stroke by a smaller amount than did the other five risk factors that accounted for a greater proportion of the population-attributable risk. The comparisons yielded odds ratios of 1.36, 1.51, 1.30/1.35, 2.38, and 1.89, respectively.

All risk factors identified in this study were significantly associated with ischemic stroke, whereas hypertension, smoking, waist:hip ratio, diet, and alcohol intake also were significantly associated with intracerebral hemorrhagic stroke, Dr. Martin J. O'Donnell of McMaster University, Hamilton, Ont., and his colleagues reported (Lancet 2010 June 18 [doi:10.1016/S0140-6736(10)60834-3]).

In an effort to establish the association of conventional and emerging risk factors with stroke, the INTERSTROKE researchers set out to perform a study similar to the INTERHEART study published in 2004, which identified nine modifiable risk factors that explained the majority of myocardial infarctions worldwide.

Between March 1, 2007, and April 23, 2010, the investigators studied 3,000 patients from 22 countries, and 3,000 sex-and age-matched controls with no stroke history. Case patients (2,337 with ischemic stroke and 663 with intracerebral hemorrhagic stroke) presented with acute first stroke, and were enrolled within 5 days of symptom onset and 72 hours of hospital admission. A structured questionnaire and physical examination, including routine neuroimaging, were performed in all patients.

"Our study provides essential information on the importance of common, potentially modifiable vascular risk factors, and builds on previous epidemiological studies," they wrote, noting that although the risk factors are similar to those identified as being associated with MI in INTERHEART, hypertension, apolipoproteins, physical activity, and alcohol intake appear to have different relative importance for stroke vs. …

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