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. 2023 Jun 20;12(12):e027888.
doi: 10.1161/JAHA.122.027888. Epub 2023 Jun 10.

Determinants of First-Ever Stroke Severity in West Africans: Evidence From the SIREN Study

Oladimeji Adebayo  1 , Onoja Akpa  2   3 , Osahon J Asowata  2 , Adekunle Fakunle  4 , Fred S Sarfo  5 , Albert Akpalu  6 , Kolawole Wahab  7 , Reginald Obiako  8 , Morenikeji Komolafe  9 , Lukman Owolabi  10 , Godwin O Osaigbovo  11 , Akinkunmi Paul Okekunle  2 , Taofiki Sunmonu  12 , Hemant K Tiwari  13 , Carolyn Jenkins  14 , Oyedunni Arulogun  15 , Lambert Appiah  5 , Joshua Akinyemi  2 , Abiodun M Adeoye  1 , Godwin Ogbole  16 , Joseph Yaria  1 , Donna Arnett  17 , Philip Adebayo  18   19 , Benedict Calys-Tagoe  6 , Okechukwu S Ogah  1 , Olayemi Balogun  8 , Luqman Ogunjimi  20 , Yaw Mensah  5 , Obiageli U Agbogu-Ike  8 , Rufus Akinyemi  21   22 , Bruce Ovbiagele  23 , Mayowa O Owolabi  1   22   24 ; SIREN
Collaborators, Affiliations

Determinants of First-Ever Stroke Severity in West Africans: Evidence From the SIREN Study

Oladimeji Adebayo et al. J Am Heart Assoc. .

Abstract

Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43-2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93-3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03-2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93-7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5-6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1-4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2-3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3-5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0-19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.

Keywords: SIREN; West Africa; determinant; stroke severity.

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Figures

Figure 1
Figure 1. Forest plot of the factors associated with stroke severity by Stroke Levity Scale (SLS) (model 1).
Figure 2
Figure 2. Forest plot of the factors associated with stroke severity by Stroke Levity Scale (SLS) (model 2).
BP indicates blood pressure; and ICH, intracerebral hemorrhage.
See this image and copyright information in PMC

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