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Multicenter Study
. 2021 Oct;30(10):106003.
doi: 10.1016/j.jstrokecerebrovasdis.2021.106003. Epub 2021 Jul 28.

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study

Onoja Akpa  1 , Fred S Sarfo  2 , Mayowa Owolabi  3 , Albert Akpalu  4 , Kolawole Wahab  5 , Reginald Obiako  6 , Morenikeji Komolafe  7 , Lukman Owolabi  8 , Godwin O Osaigbovo  9 , Godwin Ogbole  10 , Hemant K Tiwari  11 , Carolyn Jenkins  12 , Adekunle G Fakunle  13 , Samuel Olowookere  14 , Ezinne O Uvere  13 , Joshua Akinyemi  15 , Oyedunni Arulogun  13 , Josephine Akpalu  2 , Moyinoluwalogo M Tito-Ilori  13 , Osahon J Asowata  1 , Philip Ibinaiye  6 , Cynthia Akisanya  16 , Olalekan I Oyinloye  5 , Lambert Appiah  2 , Taofik Sunmonu  17 , Paul Olowoyo  18 , Atinuke M Agunloye  19 , Abiodun M Adeoye  19 , Joseph Yaria  20 , Daniel T Lackland  12 , Donna Arnett  21 , Ruth Y Laryea  22 , Taiwo O Adigun  13 , Akinkunmi P Okekunle  1 , Benedict Calys-Tagoe  23 , Okechukwu S Ogah  20 , Mayowa Ogunronbi  14 , Olugbo Y Obiabo  24 , Suleiman Y Isah  8 , Hamisu A Dambatta  8 , Raelle Tagge  25 , Obande Ogenyi  20 , Bimbo Fawale  7 , Chimdinma L Melikam  6 , Akinola Onasanya  14 , Sunday Adeniyi  5 , Rufus Akinyemi  26 , Bruce Ovbiagele  25 ; SIREN
Affiliations
Multicenter Study

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study

Onoja Akpa et al. J Stroke Cerebrovasc Dis. 2021 Oct.

Abstract

Background: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African.

Objectives: To develop Afrocentric risk-scoring models for stroke occurrence.

Materials and methods: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off.

Results: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%).

Conclusions: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.

Keywords: Africans; Risk assessment score; Risk factor; Riskometer; Stroke; Stroke investigative research and education network (SIREN).

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Figures

Fig. 1.
Fig. 1.
ROC Curves for training and testing dataset for all strokes using constant and standardised weighting.
Fig. 2.
Fig. 2.
ROC Curves for training and testing dataset for Ischemic strokes using constant and standardised weighting.
Fig. 3.
Fig. 3.
ROC Curves for training and testing dataset for Hemorrhagic strokes using constant and standardised weighting.
See this image and copyright information in PMC

References

    1. Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham study. Stroke. 1991;22:312–318. - PubMed
    1. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002;105(3):310–5. - PubMed
    1. White H, Boden-Albala B, Wang C, Elking MS, Rundek T, Wright CB, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation. 2005;111:1327–1331. - PubMed
    1. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of mproved algorithms for the assessment of global cardiovascular risk in women: the Reynolds risk score. JAMA. 2007;297:611–619. - PubMed
    1. Wu Y, Liu X, Li X, et al. Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults. Circulation. 2006;114(21):2217–25. - PubMed

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