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Multicenter Study
. 2020 Mar 10;94(10):e998-e1012.
doi: 10.1212/WNL.0000000000009056. Epub 2020 Feb 19.

Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans

Fred S Sarfo  1 , Bruce Ovbiagele  1 , Mulugeta Gebregziabher  1 , Onoja Akpa  1 , Albert Akpalu  1 , Kolawole Wahab  1 , Godwin Ogbole  1 , Rufus Akinyemi  1 , Reginald Obiako  1 , Morenikeji Komolafe  1 , Lukman Owolabi  2 , Daniel Lackland  1 , Donna Arnett  1 , Hemant Tiwari  1 , Hugh S Markus  1 , Joshua Akinyemi  1 , Ayodipupo Oguntade  1 , Bimbo Fawale  1 , Abiodun Adeoye  1 , Obiabo Olugbo  1 , Luqman Ogunjimi  1 , Godwin Osaigbovo  1 , Carolyn Jenkins  1 , Ijezie Chukwuonye  1 , Olabamiji Ajose  1 , Lekan Oyinloye  1 , Fedelis Mutiso  1 , Ruth Laryea  1 , Benedict Calys-Tagoe  1 , Abdul Salaam  1 , Ganiyu Amusa  1 , Samuel Olowookere  1 , Chidiebere Imoh  1 , Aliyu Mande  1 , Oyedunni Arulogun  1 , Fakunle Adekunle  1 , Lambert Appiah  1 , Olayemi Balogun  1 , Arti Singh  1 , Osi Adeleye  1 , Okechukwu Ogah  1 , Akintomiwa Makanjuola  1 , Dorcas Owusu  1 , Philip Kolo  1 , Oladimeji Adebayo  1 , Atinuke Agunloye  1 , Vincent Shidali  1 , Moyinoluwalogo Faniyan  1 , Sulaiman Lakoh  1 , Samuel Diala  1 , Henry Iheonye  1 , Chika Efidi  1 , Emmanuel Sanya  1 , Taofiki Sunmonu  1 , Adeseye Akintunde  1 , Mayowa Owolabi  2 ; SIREN
Collaborators, Affiliations
Multicenter Study

Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans

Fred S Sarfo et al. Neurology. .

Abstract

Objective: To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.

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.

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Figures

Figure
Figure. Forest plots show risk factors for intracerebral hemorrhage (ICH) among West Africans
(A) Odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for ICH. (B) Population attributable risks (PARs) and their 95% CIs for ICH. (C, D) ORs and PARs for nonlobar ICH. (E, F) ORs and PARs for lobar ICH. Bl = baseline; CVD = cardiovascular disease.
See this image and copyright information in PMC

Comment in

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