INTERSTROKE STUDY -> 9 modifiable factors!!

Risk Factors for Stroke: A Global Study

Nine modifiable factors account for 90% of stroke incidence worldwide.

Studies of modifiable risk factors for stroke have been conducted largely in developed countries. Few data have been collected in the developing world, where 85% of stroke mortality occurs.

Replicating in part the methodology of the 2004 INTERHEART study of risk factors for first myocardial infarction (JW Gen Med Oct 5 2004), researchers recruited 3000 patients with recent first strokes in 22 countries on 6 continents; both developing and developed countries were represented. Each case patient was matched by age and sex with a control patient from the same community who did not have a history of stroke. Virtually all case patients received neuroimaging to determine stroke type (78% ischemic; 22% hemorrhagic).

As in the INTERHEART study, a small set of modifiable risk factors was identified. In this case, nine factors — hypertension, smoking, low waist-to-hip ratio, unhealthy diet, lack of regular exercise, diabetes, moderate or high alcohol intake, stress or depression, and high ratio of apoB to apoA1 lipoprotein — accounted for 90% of the worldwide risk for stroke. Contributions of various risk factors were similar across geographic regions. Hypertension alone accounted for 52% of risk for any stroke and 74% of risk for hemorrhagic stroke. Unlike waist-to-hip ratio, body-mass index was not associated with stroke risk.

Comment: Like a first myocardial infarction, a first stroke is largely preventable. In the developing world, hypertension, which can be evaluated and treated inexpensively, should be a particular target for intervention.

— Bruce Soloway, MD

Published in Journal Watch General Medicine July 22, 2010
Citation(s):

O'Donnell MJ et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): A case-control study. Lancet 2010 Jul 10; 376:112. (http://dx.doi.org/10.1016/S0140-6736(10)60834-3)

* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7YTM2NTEwZjQtOGQyNy00ZTczLThmMjAtM2M3NTU0OWRjNTYz&hl=zh_TW

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