Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study
Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study
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DOI：
10.1016/s0140-6736(10)60834-3
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发表时间：
2010-07-10
期刊：
影响因子：
168.9
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
O'Donnell, Martin J.;Xavier, Denis;Yusuf, Salim
背景各种危险因素对全球卒中负担的影响尚不清楚，特别是在低收入和中等收入国家。我们的目的是建立已知的和新出现的危险因素与中风及其主要亚型的关联，评估这些危险因素对中风负担的贡献，并探讨中风和心肌梗死的危险因素之间的差异。方法我们进行了一项标准化的病例对照研究，在2007年3月1日至2010年4月23日之间，在全球22个国家。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）。对照组无中风史，年龄和性别与病例相匹配。所有参与者都完成了结构化问卷和体检，大多数人提供了血液和尿液样本。我们计算了所有卒中、缺血性卒中和脑出血性卒中与选定危险因素之间的比值比（OR）和人群归因风险（PAR）。（n=2337，78%，缺血性卒中; n=663，22%，脑出血性卒中）和3000例对照组，所有卒中的显著风险因素为：高血压病史（OR 2.64，99% CI 2.26-3.08; PAR 34.6%，99% CI 30.4-39.1）;目前吸烟（2.09，1.75-2.51; 18.9%，15.3-23.1）;腰臀比（最高与最低三分位数分别为1.65、1.36-1.99; 26.5%、18.8-36.0）;饮食风险评分（最高与最低三分位数分别为1.35、1.11-1.64; 18.8%、11.2-29.7）;定期体力活动（0.69，0.53-0.90; 285%，14 5-48.5）;糖尿病（1.36，1.10-1.68; 5.0%，2.6-9.5）;酒精摄入（1.51，1.18-1.92，每月饮酒超过30次或酗酒; 3 - 8%，0.9-14.4）;心理社会压力（1.30，1.06-1.60; 46%，2.1-9.6）和抑郁症（1.35，1.10-1.66; 5.2%，2.7-9.8）;心脏原因（2.38，1.77-3.20; 6.7%，4.8-9.1）;载脂蛋白B与A1的比值（1.89，1.49-2.40，最高与最低三分位数; 24.9%，15.7-37.1）。总的来说，这些风险因素占所有卒中PAR的88.1%（99%CI 82.3-92.2）。当使用高血压的替代定义（高血压史或血压>160/90 mm Hg）时，所有卒中的合并PAR为90.3%（85.3-93.7）。这些危险因素对缺血性中风都有显著意义，而高血压、吸烟、腰臀比、饮食和饮酒是脑出血性中风的显著危险因素。有针对性的干预措施，降低血压和吸烟，促进体育活动和健康饮食，可以大大减少中风的负担。
Background The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction.Methods We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days of symptoms onset and 72 h of hospital admission). Controls had no history of stroke, and were matched with cases for age and sex. All participants completed a structured questionnaire and a physical examination, and most provided blood and urine samples. We calculated odds ratios (ORs) and population-attributable risks (PARs) for the association of all stroke, ischaemic stroke, and intracerebral haemorrhagic stroke with selected risk factors.Findings In the first 3000 cases (n=2337, 78%, with ischaemic stroke; n=663, 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all stroke were: history of hypertension (OR 2.64, 99% CI 2.26-3.08; PAR 34.6%, 99% CI 30.4-39.1); current smoking (2.09, 1.75-2.51; 18.9%, 15.3-23.1); waist-to-hip ratio (1.65, 1.36-1.99 for highest vs lowest tertile; 26.5%, 18.8-36.0); diet risk score (1.35, 1.11-1.64 for highest vs lowest tertile; 18.8%, 11.2-29.7); regular physical activity (0.69, 0.53-0.90; 285%, 14 5-48.5); diabetes mellitus (1.36, 1.10-1.68; 5.0%, 2.6-9.5); alcohol intake (1.51, 1.18-1.92 for more than 30 drinks per month or binge drinking; 3 - 8%, 0.9-14.4); psychosocial stress (1.30, 1.06-1.60; 46%, 2.1-9.6) and depression (1.35, 1.10-1.66; 5.2%, 2.7-9.8); cardiac causes (2.38, 1.77-3.20; 6.7%, 4.8-9.1); and ratio of apolipoproteins B to A1 (1.89, 1.49-2.40 for highest vs lowest tertile; 24.9%, 15.7-37.1). Collectively, these risk factors accounted for 88.1% (99% CI 82.3-92.2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90.3% (85.3-93.7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebr-al haemorrhagic stroke.Interpretation Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke.