Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans.
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Sarfo Fred S, Ovbiagele Bruce, Gebregziabher Mulugeta, Akpa Onoja, Akpalu Albert, Wahab Kolawole, Ogbole Godwin, Akinyemi Rufus, Obiako Reginald, Komolafe Morenikeji, Owolabi Lukman, Lackland Daniel, Arnett Donna, Tiwari Hemant, Markus Hugh S, Akinyemi Joshua, Oguntade Ayodipupo, Fawale Bimbo, Adeoye Abiodun, Olugbo Obiabo, Ogunjimi Luqman, Osaigbovo Godwin, Jenkins Carolyn, Chukwuonye Ijezie, Ajose Olabamiji, Oyinloye Lekan, Mutiso Fedelis, Laryea Ruth, Calys-Tagoe Benedict, Salaam Abdul, Amusa Ganiyu, Olowookere Samuel, Imoh Chidiebere, Mande Aliyu, Arulogun Oyedunni, Adekunle Fakunle, Appiah Lambert, Balogun Olayemi, Singh Arti, Adeleye Osi, Ogah Okechukwu, Makanjuola Akintomiwa, Owusu Dorcas, Kolo Philip, Adebayo Oladimeji, Agunloye Atinuke, Shidali Vincent, Faniyan Moyinoluwalogo, Lakoh Sulaiman, Diala Samuel, Iheonye Henry, Efidi Chika, Sanya Emmanuel, Sunmonu Taofiki, Akintunde Adeseye, Owolabi Mayowa, SIREN
Аннотация
METHODS: The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.
RESULTS: Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46).
CONCLUSIONS: Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.