Fred S Sarfo1, Bruce Ovbiagele1, Mulugeta Gebregziabher1, Onoja Akpa1, Albert Akpalu1, Kolawole Wahab1, Godwin Ogbole1, Rufus Akinyemi1, Reginald Obiako1, Morenikeji Komolafe1, Lukman Owolabi2, Daniel Lackland1, Donna Arnett1, Hemant Tiwari1, Hugh S Markus1, Joshua Akinyemi1, Ayodipupo Oguntade1, Bimbo Fawale1, Abiodun Adeoye1, Obiabo Olugbo1, Luqman Ogunjimi1, Godwin Osaigbovo1, Carolyn Jenkins1, Ijezie Chukwuonye1, Olabamiji Ajose1, Lekan Oyinloye1, Fedelis Mutiso1, Ruth Laryea1, Benedict Calys-Tagoe1, Abdul Salaam1, Ganiyu Amusa1, Samuel Olowookere1, Chidiebere Imoh1, Aliyu Mande1, Oyedunni Arulogun1, Fakunle Adekunle1, Lambert Appiah1, Olayemi Balogun1, Arti Singh1, Osi Adeleye1, Okechukwu Ogah1, Akintomiwa Makanjuola1, Dorcas Owusu1, Philip Kolo1, Oladimeji Adebayo1, Atinuke Agunloye1, Vincent Shidali1, Moyinoluwalogo Faniyan1, Sulaiman Lakoh1, Samuel Diala1, Henry Iheonye1, Chika Efidi1, Emmanuel Sanya1, Taofiki Sunmonu1, Adeseye Akintunde1, Mayowa Owolabi2. 1. From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria. 2. From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria. mayowaowolabi@yahoo.com.
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.
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.
Authors: M O'Donnell; D Xavier; C Diener; R Sacco; L Lisheng; H Zhang; P Pias; T Truelsen; S L Chin; S Rangarajan; L Devilliers; A Damasceno; C Mondo; F Lanas; A Avezum; R Diaz; J Varigos; G Hankey; P Teal; M Kapral; D Ryglewicz; A Czlonkowska; M Skowronska; P Lopez-Jaramillo; T Dans; P Langhorne; S Yusuf Journal: Neuroepidemiology Date: 2010-04-08 Impact factor: 3.282
Authors: Fred Stephen Sarfo; John Akassi; Sheila Adamu; Vida Obese; Bruce Ovbiagele Journal: J Stroke Cerebrovasc Dis Date: 2017-06-23 Impact factor: 2.136
Authors: David Zaridze; Paul Brennan; Jillian Boreham; Alex Boroda; Rostislav Karpov; Alexander Lazarev; Irina Konobeevskaya; Vladimir Igitov; Tatiana Terechova; Paolo Boffetta; Richard Peto Journal: Lancet Date: 2009-06-27 Impact factor: 79.321
Authors: Sharyl R Martini; Matthew L Flaherty; W Mark Brown; Mary Haverbusch; Mary E Comeau; Laura R Sauerbeck; Brett M Kissela; Ranjan Deka; Dawn O Kleindorfer; Charles J Moomaw; Joseph P Broderick; Carl D Langefeld; Daniel Woo Journal: Neurology Date: 2012-11-21 Impact factor: 9.910
Authors: Fred Stephen Sarfo; John Akassi; Sheila Adamu; Vida Obese; Manolo Agbenorku; Bruce Ovbiagele Journal: J Neurol Sci Date: 2020-06-05 Impact factor: 3.181
Authors: Fred S Sarfo; Bruce Ovbiagele; Onoja Akpa; Albert Akpalu; Kolawole Wahab; Reginald Obiako; Morenikeji Komolafe; Lukman Owolabi; Godwin Ogbole; Benedict Calys-Tagoe; Adekunle Fakunle; Taofeek Sanni; Gebregziabher Mulugeta; Salaam Abdul; Adeseye A Akintunde; Samuel Olowookere; Ezinne O Uvere; Philip Ibinaiye; Joshua Akinyemi; Kelechukwu Uwanuruochi; Balogun Olayemi; Olufemi A Odunlami; Esther Abunimye; Oyedunni Arulogun; Suleiman Y Isah; Sani A Abubakar; Adebayo Oladimeji; Philip Adebayo; Vincent Shidali; Innocent I Chukwuonye; Josephine Akpalu; Moyinoluwalogo M Tito-Ilori; Osahon J Asowata; Emmanuel O Sanya; Ganiyu Amusa; Ugochukwu Onyeonoro; James A Ogunmodede; Abdullateef G Sule; Cynthia Akisanya; Yaw Mensah; Olalekan I Oyinloye; Lambert Appiah; Atinuke M Agunloye; Godwin O Osaigbovo; Eunice Olabinri; Philip M Kolo; Obiora Okeke; Abiodun M Adeoye; Olabamiji Ajose; Carolyn Jenkins; Daniel T Lackland; Adedeji A Egberongbe; Olaleye Adeniji; Osimhiarherhuo Ohifemen Adeleye; Hemant K Tiwari; Donna Arnett; Ruth Y Laryea; Taiwo Olunuga; Kazeem S Akinwande; Lucius Imoh; Okechukwu S Ogah; Ezinne S Melikam; Adeyemo Adebolaji; Wisdom Oguike; Olumayowa Ogunronbi; Wasiu Adeniyi; Obiabo Y Olugbo; Abiodun H Bello; Kenneth A Ohagwu; Luqman Ogunjimi; Francis Agyekum; Henry Iheonye; Julius Adesina; Samuel Diala; Hamisu A Dambatta; Joyce Ikubor; Arti Singh; Sheila Adamu; Vida Obese; Nathaniel Adusei; Dorcas Owusu; Michael Ampofo; Raelle Tagge; Richard Efidi; Bimbo Fawale; Joseph Yaria; Rufus Akinyemi; Mayowa Owolabi Journal: Stroke Date: 2021-09-30 Impact factor: 7.914