Retrospective cohort study on risk factors for developing ischemic stroke

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Ischemic stroke, Model, Modifiable and non-modifiable, Predictors, Risk factors


Background: There is a paucity of studies describing the risk factors for developing ischemic stroke in our region. Objective: The objective of the current study was to delineate the potential risk factors for the development of ischemic stroke. Methods: We have conducted a retrospective cohort hospitalbased study that has enrolled 231 subjects. The subjects have had presented to the emergency department in a tertiary hospital in the United Arab Emirates. Subjects were diagnosed with ischemic stroke within 24 hours of presentation. Outcome measure: The main outcome measure was the development of ischemic stroke during an indexed hospital visit. Results: The mean age was 47.5 ±3.2 with a higher preponderance of males over females (60.9%) and 48.1% were ≥ 65 years. The final logistic regression model for the development of ischemic stroke contains seven variables. In descending order, the seven predictive risk factors for the development of ischemic stroke were: hypertension (OR 6.1, CI 2.4-9.5; P = 0.029), coronary artery disease (OR 4.2, 3.7-9.1; P = 0.038), low physical activity (OR 4.2, CI 2.1-9.1; P = 0.035), history of previous stroke (OR 4.1, 1.4-3.4; P = 0.033), atrial fibrillation (OR 3.2, CI 2.6-8.2; P = 0.017), family history of stroke (OR 3.1, 1.3-6.9; P = 0.042) and diabetes mellitus (OR 2.7, CI 1.25-6.1; P = 0.035). The specificity of the model was 58.1%; the sensitivity was 86.1%, and the overall accuracy was 75.7%. Conclusion: It is prudent to control modifiable risk factors for the development of strokes such as hypertension, diabetes, atrial fibrillation, coronary artery disease, and low physical activity.


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1. Global Burden of Diseases (GBD). Mortality and Causes of Death Collaborators. Global, regional, and national age–sexspecific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the G lobal Burden
of Disease Study 2013. Lancet. 2015;385(9963):117-171.
2. Feigin VL, Krishnamurthi RV, Parmar P, et al. Global Burden of Diseases (GBD). 2013 Writing Group; GBD 2013 Stroke
Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology. 2015;45(3):161-176.
3. Bamford J, Sandercock P, Dennis M, et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337(8756):1521-1526.
4. Barker-Collo S, Bennett DA, Krishnamurthi RV, et al. GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013. Neuroepidemiology. 2015;45(3):203-214.
5. Lloyd-Jones D, Adams R, Carnethon M, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):e21-181.
6. Go AS, Mozaffarian D, Roger VL, et al. American Heart Association Statistics Committee and Stroke Statistics
Subcommittee. Heart disease and stroke statistics–-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.
7. Krishnamurthi RV, Moran AE, Feigin VL, et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015;45(3):190-202.
8. Kissela BM, Khoury JC, Alwell K, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population.  Neurology. 2012;79(17):1781-1787.
9. George MG, Tong X, Kuklina EV, et al. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol. 2011;70(5):713-721.
10. Williams PT. Reduction in incident stroke risk with vigorous physical activity: evidence from 7.7-year follow-up of the National Runners’ Health Study. Stroke. 2009;40(5):1921-1923.
11. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The Lancet. 2006;367(9524):1747-1757.
12. Flossmann E, Schulz U, Rothwell P. Systematic review of methods and results of studies of the genetic epidemiology of ischemic stroke. Stroke. 2004;35(1):212-227.
13. Scarborough P, Morgan RD, Webster P, et al. Differences in coronary heart disease, stroke and cancer mortality rates between
England, Wales, Scotland and Northern Ireland: the role of diet and nutrition. BMJ Open. 2011;1(1):e000263. https://doi.
14. O’Donnell MJ, Chin SL, Rangarajan S, et al. INTERSTROKE Investigators. Global and regional effects of poten- tially modifiable
risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-
15. Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947-
16. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Wiley and Sons. 1989.
17. Hosmer DW, Lemeshow S. Applied logistic regression. 3rd ed. New York: John Wiley and Sons. 2000.
18. El Tallawy HN, Farghaly WM, Badry R, et al. Epidemiology and clinical presentation of stroke in Upper Egypt (desert area).  Neuropsychiatr Dis Treat. 2015;11:2177-2183.
19. Muchada M, Rubiera M, Rodriguez-Luna D, et al. Baseline National Institutes of Health Stroke Scale–Adjusted. Time Window for Intravenous Tissue-Type Plasminogen. Activator in Acute Ischemic Stroke. Stroke. 2014; 45(4):1059-1063.
20. Fabris F, Zanocchi M, Bo M, et al. Carotid plaque, aging, and risk factors. A study of 457 subjects. Stroke. 1994;25(6):1133-1140.
21. Knoflach M, Matosevic B, Rücker M, et al. Austrian Stroke Unit Registry Collaborators. Functional recovery after ischemicstroke--a matter of age: data from the Austrian Stroke Unit Registry. Neurology. 2012;78(4):279-285. WNL.0b013e31824367ab
22. Choi JC, Lee JS, Kang SY, et al. Family history and risk for ischemic stroke: sibling history is more strongly correlated with the disease than parental history. J Neurol Sci. 2009;284(1-2):29-32.
23. Flossmann E, Schulz UG, Rothwell PM. Systematic review of methods and results of studies of the genetic epidemiologyofischemic stroke. Stroke. 2004;35(1):212-227.
24. Altafi D, Khotbesara M, Khotbesara M, et al. A comparative study OF NIHSS between ischemic stroke patients with and without risk factors. Tech J Eng Appl Sci. 2013;3(17):1954-1957.
25. Soliman RH, Oraby MI, Fathy M, et al. Risk factors of acute ischemic stroke in patients presented to Beni-Suef UniversityHospital: prevalence and relation to stroke severity at presentation. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):8.
26. Patlolla SH, Lee HC, Noseworthy PA, et al. Impact of Diabetes Mellitus on Stroke and Survival in Patients with Atrial Fibrillation. Am J Cardiol. 2020;131:33-39.
27. Essa A, Helmy T, El Batch S. Study of incidence, risk factors and outcome of acute cerebrovascular stroke patients admitted to Alexandria Main University Hospital. J Am Sci. 2011;7(11):316-329.
28. Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol. 2005;105(3):315-318.
29. Fohtung RB, Rich MW. Identification of patients at risk of stroke from atrial fibrillation. Risk. 2016;5(12):6.
30. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA.2001;285(18):2370-2375.
31. Bokma JP, Zegstroo I, Kuijpers JM, et al. Factors associated with coronary artery disease and stroke in adults with congenital heart disease. Heart. 2018;104(7):574-580.
32. de Oliveira Diniz DL, Barreto PR, Carvalhedo de Bruin PF, et al. Wake-up stroke: Clinical characteristics, sedentary lifestyle,and daytime sleepiness. Rev Assoc Med Bras. 2016;62(7):628-634.
33. Basaraba J, Picard M, George-Phillips K, et al. Pharmacists as Care Providers for Stroke Patients: A Systematic Review. Can J Neurol Sci. 2018;45(1):49-55.
34. Wang J, Wang J, Qiu S, et al. Pharmaceutical care program for ischemic stroke patients: a randomized controlled trial. Int J ClinPharm. 2021;43(5):1412-1419.
35. Chen Q, Jin Z, Zhang P, et al. Characteristics of drug-related problems among hospitalized ischemic stroke patients in China. Int J Clin Pharm. 2020;42(4):1237-1241.

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