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Abstract
Objective To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.
Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.
Results Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); nonconsumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46).
Conclusions Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.
Glossary
- aOR=
- adjusted odds ratio;
- BP=
- blood pressure;
- CI=
- confidence interval;
- CVD=
- cardiovascular disease;
- DM=
- diabetes mellitus;
- FBG=
- fasting blood glucose;
- HDL-C=
- high-density lipoprotein cholesterol;
- ICH=
- intracerebral hemorrhage;
- INR=
- international normalized ratio;
- LDL-C=
- low-density lipoprotein cholesterol;
- LMIC=
- low and middle-income countries;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- OXVASC=
- Oxford Vascular Study;
- PAR=
- population-attributable risk;
- QVSFS=
- Questionnaire for Verifying Stroke-Free Status;
- SBP=
- systolic blood pressure;
- sICH=
- spontaneous intracerebral hemorrhage;
- SIREN=
- Stroke Investigative Research and Educational Networks;
- SMASH-U=
- structural lesions such as aneurysms/arteriovenous malformations, medication-related, amyloid angiopathy, systemic/other disease, hypertension, and undetermined causes;
- SSA=
- sub-Saharan Africa;
- TC=
- total cholesterol;
- TG=
- triglycerides;
- WHR=
- waist-to-hip ratio
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The SIREN coinvestigators are listed in appendix 2 at the end of this article.
Editorial, page 417
- Received March 9, 2019.
- Accepted in final form September 26, 2019.
- © 2020 American Academy of Neurology
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