Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study-猫眼课题宝

DOI：

10.1016/s0140-6736(16)30506-2

发表时间：

2016-08-20

期刊：

LANCET

影响因子：

168.9

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

O'Donnell, Martin J.;Chin, Siu Lim;Yusuf, Salim

中风是导致死亡和残疾的主要原因，尤其是在低收入和中等收入国家。我们试图量化的重要性，潜在的可改变的危险因素中风在不同地区的世界，并在关键人群和主要病理亚型stroke.Methods我们完成了一项标准化的国际病例对照研究，在32个国家在亚洲，美洲，欧洲，澳大利亚，中东和非洲。病例为急性首次卒中患者（症状发作5天内和入院72小时内）。对照组为无卒中史的医院或社区个体，并与病例匹配，年龄和性别以1：1的比例招募。所有参与者都完成了临床评估，并被要求提供血液和尿液样本。结果2007年1月11日至2015年8月8日期间，从32个国家招募了26919名参与者（13447例[10388例缺血性卒中和3059例脑出血]和13472例对照）。既往有高血压史或血压≥ 140/90 mm Hg（OR 2.98，99% CI 2.72-3.28; PAR 47.9%，99% CI 45.1-50.6），定期体力活动（0.60，0.52-0.70; 35.8%，27.7-44.7），载脂蛋白（Apo）B/ApoA 1比值（1.84，1.65-2.06）; 26.8%，前两个三分位数为22.2-31.9，最低三分位数为22.2-31.9），饮食（改良艾德替代健康饮食指数[mAHEI]的最高与最低三分位数分别为0.60、0.53-0.67; 23.2%，最低两个三分位数与最高三分位数的mAHEI为18.2-28.9），腰臀比（最高与最低三分位数分别为1.44、1.27-1.64;前两个三分位数分别为18.6%、13.3-25.3），心理社会因素（2.20，1.78-2.72; 17.4%，13.1-22.6），目前吸烟（1.67，1.49-1.87; 12.4%，10.2-14.9），心脏原因（3.17，2.68-3.75; 9.1%，8.0-10.2），饮酒（2.09，1.64-2.67，高或重间歇性摄入与从不或以前饮酒者相比; 5.8%，3.4-9.7，当前饮酒者与从不或以前饮酒者相比），和糖尿病（1.16，1.05-1.30; 3.9%，1.9-7.6）与所有卒中相关。总体而言，这些风险因素占全球所有卒中PAR的90.7%（缺血性卒中为91.5%，脑出血为87.1%），并且在不同地区（从非洲的82.7%到东南亚的97.4%）、性别（男性和女性为90.6%）和年龄组（55岁患者为92.2%）之间一致。我们观察到个别风险因素的重要性存在地区差异，这与OR的大小变化（而不是我们观察到的饮食方向）以及地区间风险因素患病率的差异有关。与缺血性卒中相比，高血压与脑出血的相关性更大，而目前吸烟、糖尿病、载脂蛋白和心脏原因与缺血性卒中的相关性更大（p

Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1: 1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [ 10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2.98, 99% CI 2.72-3.28; PAR 47.9%, 99% CI 45.1-50.6), regular physical activity (0.60, 0.52-0.70; 35.8%, 27.7-44.7), apolipoprotein (Apo) B/ApoA1 ratio (1.84, 1.65-2.06 for highest vs lowest tertile; 26.8%, 22.2-31.9 for top two tertiles vs lowest tertile), diet (0.60, 0.53-0.67 for highest vs lowest tertile of modifi ed Alternative Healthy Eating Index [mAHEI]; 23.2%, 18.2-28.9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1.44, 1.27-1.64 for highest vs lowest tertile; 18.6%, 13.3-25.3 for top two tertiles vs lowest), psychosocial factors (2.20, 1.78-2.72; 17.4%, 13.1-22.6), current smoking (1.67, 1.49-1.87; 12.4%, 10.2-14.9), cardiac causes (3.17, 2.68-3.75; 9.1%, 8.0-10.2), alcohol consumption (2.09, 1.64-2.67 for high or heavy episodic intake vs never or former drinker; 5.8%, 3.4-9.7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1.16, 1.05-1.30; 3.9%, 1.9-7.6) were associated with all stroke. Collectively, these risk factors accounted for 90.7% of the PAR for all stroke worldwide (91.5% for ischaemic stroke, 87.1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82.7% in Africa to 97.4% in southeast Asia), sex (90.6% in men and in women), and age groups (92.2% in patients aged 55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

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