Esther Abunimye, Osahon J Asowata, Gebregziabher Mulugeta, Obiora Okeke, Adeyemo Adebolaji, Michael Ampofo, Adebayo Oladimeji, Olumayowa Ogunronbi, Henry Iheonye, Abiodun H Bello, Philip M Kolo, Arti Singh, Godwin Osaigbovo, Josephine Akpalu, Godwin Ogbole, Osimhiarherhuo Adeleye, Ganiyu Amusa, Oyedunni Arulogun, Ugochukwu U Onyeonoro, Luqman Ogunjimi, Balogun Olayemi, Olabamiji Ajose, Bimbo Fawale, Daniel T. Lackland, Philip Oluleke Ibinaiye, Albert Akpalu, Lukman Owolabi, Sheila Adamu, Dorcas Owusu, Samuel Anu Olowookere, Suleiman Y Isah, Olufemi A Odunlami, Olaleye Adeniji, Wisdom Oguike, Benedict Calys-Tagoe, Adeseye A Akintunde, Philip Adebayo, Taofeek Sanni, Joseph Yaria, Adekunle Fakunle, Donna K. Arnett, Ezinne Uvere, Kenneth Arinze Ohagwu, Ezinne Melikam, Carolyn Jenkins, Lambert Tetteh Appiah, Kelechukwu Uwanuruochi, Taiwo Olunuga, J.A. Ogunmodede, Olalekan I Oyinloye, Moyinoluwalogo M Tito-Ilori, Morenikeji A. Komolafe, Richard Efidi, Salaam Abdul, SA Abubakar, Lucius Chidiebere Imoh, Francis Agyekum, Vincent Shidali, Reginald Obiako, Ruth Laryea, Innocent Ijezie Chukwuonye, Cynthia O Akisanya, Eunice Olabinri, Samuel Diala, Kazeem Akinwande, Nathaniel Adusei, Fred Stephen Sarfo, Kolawole Wahab, Abiodun M. Adeoye, Vida Obese, Emmanuel O Sanya, Atinuke M Agunloye, Sule Ag, Onoja Akpa, Raelle Tagge, Y. B. Mensah, Obiabo Olugbo, Joyce Ikubor, Hamisu A Dambatta, Julius Adesina, Wasiu Adeniyi, Adedeji A Egberongbe, Mayowa O. Owolabi, Okechukwu S Ogah, Rufus Akinyemi, Bruce Ovbiagele, Hemant K. Tiwari, and Joshua Akinyemi
Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.