Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Fred S Sarfo¹, Bruce Ovbiagele², Onoja Akpa^{3

4}, Albert Akpalu⁵, Kolawole Wahab⁶, Reginald Obiako⁷, Morenikeji Komolafe⁴, Lukman Owolabi⁸, Godwin Ogbole⁹, Benedict Calys-Tagoe¹⁰, Adekunle Fakunle¹¹, Taofeek Sanni¹², Gebregziabher Mulugeta¹³, Salaam Abdul¹⁴, Adeseye A Akintunde¹⁵, Samuel Olowookere⁴, Ezinne O Uvere¹¹, Philip Ibinaiye⁷, Joshua Akinyemi⁵, Kelechukwu Uwanuruochi¹⁶, Balogun Olayemi⁷, Olufemi A Odunlami¹⁷, Esther Abunimye⁸, Oyedunni Arulogun¹⁸, Suleiman Y Isah⁸, Sani A Abubakar⁷, Adebayo Oladimeji, Philip Adebayo¹⁹, Vincent Shidali²⁰, Innocent I Chukwuonye¹⁶, Josephine Akpalu¹⁰, Moyinoluwalogo M Tito-Ilori¹¹, Osahon J Asowata^{2

3

18}, Emmanuel O Sanya⁶, Ganiyu Amusa¹⁴, Ugochukwu Onyeonoro¹⁶, James A Ogunmodede⁶, Abdullateef G Sule⁷, Cynthia Akisanya¹⁷, Yaw Mensah²¹, Olalekan I Oyinloye⁶, Lambert Appiah²², Atinuke M Agunloye⁵, Godwin O Osaigbovo¹⁴, Eunice Olabinri¹², Philip M Kolo⁶, Obiora Okeke¹⁶, Abiodun M Adeoye⁵, Olabamiji Ajose⁵, Carolyn Jenkins¹³, Daniel T Lackland¹³, Adedeji A Egberongbe²³, Olaleye Adeniji¹⁷, Osimhiarherhuo Ohifemen Adeleye¹⁷, Hemant K Tiwari²⁴, Donna Arnett²⁵, Ruth Y Laryea¹⁰, Taiwo Olunuga¹⁷, Kazeem S Akinwande¹⁷, Lucius Imoh¹⁴, Okechukwu S Ogah, Ezinne S Melikam, Adeyemo Adebolaji¹⁰, Wisdom Oguike⁷, Olumayowa Ogunronbi¹⁶, Wasiu Adeniyi¹⁷, Obiabo Y Olugbo²⁶, Abiodun H Bello⁶, Kenneth A Ohagwu¹⁶, Luqman Ogunjimi²⁷, Francis Agyekum²⁸, Henry Iheonye²⁹, Julius Adesina¹⁷, Samuel Diala¹¹, Hamisu A Dambatta⁸, Joyce Ikubor²⁵, Arti Singh¹, Sheila Adamu²², Vida Obese²², Nathaniel Adusei²², Dorcas Owusu¹, Michael Ampofo²², Raelle Tagge², Richard Efidi, Bimbo Fawale⁴, Joseph Yaria, Rufus Akinyemi¹⁷, Mayowa Owolabi¹¹; SIREN

Affiliations

¹ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.S., A.S., D.O.).
² Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco (B.O., O.J.A., R.T.).
³ Department of Epidemiology and Medical Statistics (O.A., O.J.A.), an College of Medicine, University of Ibadan.
⁴ Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (M.K., S.O., O.A., B.F.).
⁵ College of Medicine (J.A., O.A., A.M.A., A.M.A., A.A.), an College of Medicine, University of Ibadan.
⁶ Department of Medicine, University of Ilorin Teaching Hospital, Nigeria (K.W., E.O.S., J.A.O., O.I.O., P.M.K., A.H.B.).
⁷ Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., P.I., B.O., S.A.A., A.G.S., W.O.).
⁸ Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., E.A., S.Y.I., H.A.D.).
⁹ Department of Radiology (G.O.), an College of Medicine, University of Ibadan.
¹⁰ Department of Medicine, University of Ghana Medical School, Accra (A.A., B.C.-T., J.A., R.Y.L.).
¹¹ Department of Medicine (A.F., E.O.U., M.M.T.-I., M.O.,S.D., M.O.), an College of Medicine, University of Ibadan.
¹² Federal Teaching Hospital, Ido-Ekiti, Ado-Ekiti, Nigeria (T.S., E.O.).
¹³ Medical University of South Carolina, Charleston (G.M., C.J., D.T.L.).
¹⁴ Jos University Teaching Hospital Jos, Nigeria (S.A., G.A., G.O.O., L.I.).
¹⁵ Ladoke Akintola University of Technology/Teaching Hospital, Ogbomosho, Nigeria (A.A.A.).
¹⁶ Federal Medical Centre Umuahia, Nigeria (K.U., I.I.C., U.O., O.O., K.A.O.).
¹⁷ Federal Medical Centre, Abeokuta, Nigeria (O.A.O., C.A., O.A., O.O.A., T.O., K.S.A., W.A., J.A., R.A.).
¹⁸ Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases (O.A., O.J.A.), an College of Medicine, University of Ibadan.
¹⁹ University College Hospital, Ibadan, Nigeria Aga Khan University Dar es Salaam, Tanzania (P.A.).
²⁰ Federal Medical Centre, Keffi Zaria, Nigeria (V.S.).
²¹ Korle Bu Teaching Hospital, Accra, Ghana (Y.M.).
²² Komfo Anokye Teaching Hospital Kumasi, Ghana (L.A., S.A., V.O., N.A., M.A.).
²³ Federal Medical Centre, Owo, Ondo State, Nigeria (A.A.E.).
²⁴ University of Alabama at Birmingham, Alabama (H.K.T.).
²⁵ College of Public Health, University of Kentucky (D.A., J.I.).
²⁶ Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria (O.Y.O.).
²⁷ Department of Pharmacology and Therapeutics, Olabisi Onabanjo University. Abeokuta, Nigeria (L.O.).
²⁸ Greater Accra Regional Hospital, Accra, Ghana (F.A.).
²⁹ Federal Medical Centre, Lokoja, Kogi state, Nigeria (H.I.).

PMID: 34587795
PMCID: PMC8712357
DOI: 10.1161/STROKEAHA.120.032072

Multicenter Study

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Fred S Sarfo et al. Stroke. 2022 Jan.

. 2022 Jan;53(1):134-144.

doi: 10.1161/STROKEAHA.120.032072. Epub 2021 Sep 30.

Authors

Affiliations

¹ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (F.S.S., A.S., D.O.).
² Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco (B.O., O.J.A., R.T.).
³ Department of Epidemiology and Medical Statistics (O.A., O.J.A.), an College of Medicine, University of Ibadan.
⁴ Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (M.K., S.O., O.A., B.F.).
⁵ College of Medicine (J.A., O.A., A.M.A., A.M.A., A.A.), an College of Medicine, University of Ibadan.
⁶ Department of Medicine, University of Ilorin Teaching Hospital, Nigeria (K.W., E.O.S., J.A.O., O.I.O., P.M.K., A.H.B.).
⁷ Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O., P.I., B.O., S.A.A., A.G.S., W.O.).
⁸ Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria (L.O., E.A., S.Y.I., H.A.D.).
⁹ Department of Radiology (G.O.), an College of Medicine, University of Ibadan.
¹⁰ Department of Medicine, University of Ghana Medical School, Accra (A.A., B.C.-T., J.A., R.Y.L.).
¹¹ Department of Medicine (A.F., E.O.U., M.M.T.-I., M.O.,S.D., M.O.), an College of Medicine, University of Ibadan.
¹² Federal Teaching Hospital, Ido-Ekiti, Ado-Ekiti, Nigeria (T.S., E.O.).
¹³ Medical University of South Carolina, Charleston (G.M., C.J., D.T.L.).
¹⁴ Jos University Teaching Hospital Jos, Nigeria (S.A., G.A., G.O.O., L.I.).
¹⁵ Ladoke Akintola University of Technology/Teaching Hospital, Ogbomosho, Nigeria (A.A.A.).
¹⁶ Federal Medical Centre Umuahia, Nigeria (K.U., I.I.C., U.O., O.O., K.A.O.).
¹⁷ Federal Medical Centre, Abeokuta, Nigeria (O.A.O., C.A., O.A., O.O.A., T.O., K.S.A., W.A., J.A., R.A.).
¹⁸ Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases (O.A., O.J.A.), an College of Medicine, University of Ibadan.
¹⁹ University College Hospital, Ibadan, Nigeria Aga Khan University Dar es Salaam, Tanzania (P.A.).
²⁰ Federal Medical Centre, Keffi Zaria, Nigeria (V.S.).
²¹ Korle Bu Teaching Hospital, Accra, Ghana (Y.M.).
²² Komfo Anokye Teaching Hospital Kumasi, Ghana (L.A., S.A., V.O., N.A., M.A.).
²³ Federal Medical Centre, Owo, Ondo State, Nigeria (A.A.E.).
²⁴ University of Alabama at Birmingham, Alabama (H.K.T.).
²⁵ College of Public Health, University of Kentucky (D.A., J.I.).
²⁶ Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria (O.Y.O.).
²⁷ Department of Pharmacology and Therapeutics, Olabisi Onabanjo University. Abeokuta, Nigeria (L.O.).
²⁸ Greater Accra Regional Hospital, Accra, Ghana (F.A.).
²⁹ Federal Medical Centre, Lokoja, Kogi state, Nigeria (H.I.).

PMID: 34587795
PMCID: PMC8712357
DOI: 10.1161/STROKEAHA.120.032072

Abstract

Background and purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans.

Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI.

Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001).

Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Keywords: atherosclerosis; dyslipidemia; hypertension; ischemic stroke; risk factors.

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Figures

**Figure 1.**
Forest plots showing risk factors of Ischemic stroke and subtypes among West Africans. (A) Odds ratios and 95% CI of risk factors, (B) PARs and their 95% CI for all ischemic stroke; (C) and (D) show odds ratios and PARs respectively for small-vessel occlusion; (E) shows odds ratios for large-vessel atherosclerotic ischemic strokes; (F) show odds ratios for Cardio-embolic stroke.

**Figure 2:**
Dose-response associations between income level, salt intake, meat intake and vegetable consumption with occurrence of ischemic stroke. Adjusted odds ratio with 95% Confidence intervals are presented.

**Figure 3.**
Comparison of number of vascular risk factors per ischemic stroke cases versus stroke-free controls.

See this image and copyright information in PMC

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Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Affiliations

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans

Authors

Affiliations

Abstract

Figures

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical