Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study
Authors: Mayowa O Owolabi, Fred Sarfo, Rufus Akinyemi, Mulugeta Gebregziabher, Onoja Akpa, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Lukman Owolabi, Bruce Ovbiagele, Mayowa Ojo Owolabi, Fred Stephen Sarfo, Rufus Akinyemi, Mulugeta Gebregziabher, Onoja Akpa, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Lukman Owolabi, Bruce Ovbiagele, Hemant K Tiwari, Donna Arnett, Daniel Lackland, Abiodun Moshood Adeoye, Ojagbemi Akin, Godwin Ogbole, Carolyn Jenkins, Oyedunni Arulogun, Irvin Marguerite Ryan, Kevin Armstrong, Paul Olowoyo, Morenikeji Komolafe, Godwin Osaigbovo, Olugbo Obiabo, Innocent Chukwuonye, Philip Adebayo, Oladimeji Adebayo, Ayanfe Omololu, Folajimi Otubogun, Adeniji Olaleye, Amina Durodola, Taiwo Olunuga, Kazeem Akinwande, Mayowa Aridegbe, Bimbo Fawale, Omisore Adeleye, Philip Kolo, Lambert Appiah, Arti Singh, Sheila Adamu, Dominic Awuah, Raelle Saulson, Francis Agyekum, Vincent Shidali, Okechukwu Ogah, Ayodipopo Oguntade, Kelechi Umanruochi, Henry Iheonye, Lucius Imoh, Tolulope Afolaranmi, Benedict Calys-Tagoe, Obiora Okeke, Adekunle Fakunle, Joshua Akinyemi, Josephine Akpalu, Philip Ibinaiye, Atinuke Agunloye, Taofeeq Sanni, Ayotunde Bisi, Chika Efidi, Andrew Bock-Oruma, Sylvia Melikam, Lanre Olaniyan, Joseph Yaria, Chidi Joseph Odo, Sulaiman Lakoh, Luqman Ogunjimi, Abdul Salaam, Lekan Oyinloye, Caroline Asaleye, Emmanuel Sanya, Samuel Olowookere, Akintomiwa Makanjuola, Ayobami Oguntoye, Ezinne Uvere, Moyinoluwalogo Faniyan, Adeseye Akintunde, Issa Kehinde, Samuel Diala, Osimhiarherhuo Adeleye, Olabanji A. Ajose, Ugochukwu Onyeonoro, Adeniyi G. Amusa, Dorcas Owusu, Yaw Mensah
Journal: The Lancet Global Health (2018)

BackgroundSub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs.FindingsBetween Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59·0 years (SD 13·8) for cases and 57·8 years (13·7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six (<1%) had discrete ischaemic and haemorrhagic lesions. 98·2% (95% CI 97·2–99·0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19·36 (95% CI 12·11–30·93) and 90·8% (95% CI 87·9–93·7) for hypertension, 1·85 (1·44–2·38) and 35·8% (25·3–46·2) for dyslipidaemia, 1·59 (1·19–2·13) and 31·1% (13·3–48·9) for regular meat consumption, 1·48 (1·13–1·94) and 26·5% (12·9–40·2) for elevated waist-to-hip ratio, 2·58 (1·98–3·37) and 22·1% (17·8–26·4) for diabetes, 2·43 (1·81–3·26) and 18·2% (14·1–22·3) for low green leafy vegetable consumption, 1·89 (1·40–2·54) and 11·6% (6·6–16·7) for stress, 2·14 (1·34–3·43) and 5·3% (3·3–7·3) for added salt at the table, 1·65 (1·09–2·49) and 4·3% (0·6–7·9) for cardiac disease, 2·13 (1·12–4·05) and 2·4% (0·7–4·1) for physical inactivity, and 4·42 (1·75–11·16) and 2·3% (1·5–3·1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence.InterpretationImplementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans.FundingNational Institutes of Health.