Population-based stroke risk profile from a West-African community

The Significance of the WHO/ISH Absolute Cardiovascular Risk Prediction Scores among Recent Stroke Survivors in Ghana-Insights from the PINGS2 multicenter study

Background

The leading cause of stroke remains atherosclerotic cardiovascular disease. The World Health Organization/International Society of Hypertension risk score represents an effort to produce a risk assessment tool for atherosclerotic cardiovascular disease that is regionally specific. No previous work has described absolute cardiovascular risk scores among recent stroke survivors in West Africa via this tool.

Methods

A cross-sectional analysis of baseline data from the multicenter, phase III randomized, open-label, clinical trial, Phone-based Intervention under Nurse Guidance II (PINGS-2), was performed. Data from 414 participants who had recently survived a stroke and met the age range compatible with the risk estimation tool were analyzed. The WHO/ISH score was calculated for each participant and categorized into low, moderate, and high/very high CVD risk scores. Demographic data, medical histories, anthropometry, vascular risk profiles, stroke types and severity indices were compared across CVD risk categories. Multivariate logistic regression was performed to further examine variables significantly associated with WHO/ISH CVD risk via univariate analysis.

Results

The mean age of the study population was 58 years (SD = 12), with the majority being male (56.5%). Ischemic strokes (n = 263, 74.3%) were more common than hemorrhagic strokes (n = 78, 22%). Over two-thirds (76.3%) of the participants were estimated to have a low (< 10%) risk of cardiovascular disease in the next 10 years, 14.5% were estimated to have a moderate risk, and only 9.2% were stratified as high or very high risk. The absolute CVD risk score was significantly associated with age, higher income, tobacco use, systolic blood pressure and HBA1c. There was no significant difference in absolute cardiovascular risk by stroke type.

Conclusion

A comparatively lower proportion of Ghanaian stroke survivors were classified as high risk by the WHO/ISH risk score. This raises the question of its appropriateness as a cardiovascular risk assessment tool to drive secondary prevention among this patient population.

Trial registration

NCT04404166. Registered on May 27,2020 at ClinicalTrials.gov.

From Gene Discovery to Stroke Risk: C5orf24's Pivotal Role Uncovered

Stroke is a leading cause of death and disability worldwide. It is crucial to understand the influencing factors and potential mechanisms of stroke, as well as reducing its risk. This study identified the expression of the B230219D22Rik gene in mouse microglial cells, corresponding to the human gene C5orf24, using the NCBI database. We then validated the role of C5orf24 in stroke using quantitative real-time PCR, enzyme-linked immunosorbent assay, western blot and Mendelian randomization (MR) analysis. Additionally, we evaluated the causal association of C5orf24 with three other vascular diseases: coronary heart disease, myocardial infarction, and embolism. The gene B230219D22Rik and C5orf24 expressed in microglia was observed to have reduced expression in mouse and human cell stroke models, respectively. In MR analysis, we found a significant causal relationship between increased C5orf24 levels and reduced stroke risk (OR = 0.68, 95% CI 0.48-0.98, P = 4.07 × 10-2). However, this association was not observed in three other vascular diseases. To further explore the function of C5orf24 in stroke, we overexpressed C5orf24 in the oxygen-glucose deprivation/reperfusion (OGD/R) model of human microglial cell line clone 3 (HMC3) in vitro and found that C5orf24 inhibited the expression of inflammatory factors IL-1β and IL-6. In our study, we revealed a causal relationship between elevated levels of C5orf24 and a reduced risk of stroke through cell experiments and MR analysis, and found that inflammation might play a mediating role. This suggests that C5orf24 could be a promising drug target for stroke treatment.

Mendelian randomization studies of lifestyle-related risk factors for stroke: a systematic review and meta-analysis

Objective

Stroke risk factors often exert long-term effects, and Mendelian randomization (MR) offers significant advantages over traditional observational studies in evaluating the causal impact of these factors on stroke. This study aims to consolidate and evaluate the relationships between potential causal factors and stroke risk, drawing upon existing MR research.

Methods

A comprehensive search for MR studies related to stroke was conducted up to August 2023 using databases such as PubMed, Web of Science, Embase, and Scopus. This meta-analysis examines the relationships between potential causative factors and stroke risk. Both random-effects and fixed-effects models were utilized to compile the dominance ratios of various causative elements linked to stroke. The reliability of the included studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology incorporating Mendelian Randomization (STROBE-MR) guidelines.

Results

The analysis identified several risk factors for stroke, including obesity, hypertension, low-density lipoprotein cholesterol (LDL-C), chronic kidney disease (CKD), and smoking. Protective factors included high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR), and educational attainment. Subgroup analysis revealed that type 2 diabetes mellitus (T2DM), diastolic blood pressure (DBP) are risk factors for ischemic stroke (IS).

Conclusion

This study confirms that variables such as obesity, hypertension, elevated LDL-C levels, CKD, and smoking are significantly linked to the development of stroke. Our findings provide new insights into genetic susceptibility and potential biological pathways involved in stroke development.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024503049.

Comparison of performances of SIREN or MFSRS in stroke risk prediction in an African environment

BACKGROUND

The Modified Framingham Stroke Risk Score (MFSRS) is a widely utilized stroke risk assessment algorithm usually applied in international comparison. The Stroke Investigative Research and Educational Network (SIREN) is the only known African-specific stroke risk assessment algorithm.

AIMS AND OBJECTIVES

To compare stroke risk estimates from the SIREN and the MFSRS in an African community.

METHODS

This was a population-based cross-sectional survey involving consecutively recruited 310 consenting adult residents (mean age = 37.21 ± 15.84 years) of a Nigerian community. Risk factors of stroke were assessed among the participants and were utilized in calculating stroke risk estimates on the MFSRS and the SIREN. The obtained data were analyzed using descriptive statistics and the Spearman-rank order correlation test at an alpha level of 0.05.

RESULTS

The percentage stroke risk scores estimated by the SIREN and the MFSRS were 34.5% and 6.79% respectively. The most prevalent risk factors among the participants were hypertriglyceridemia (100.0%), raised waist-hip ratio (50.6%), hypercholesterolemia (45.5), physical inactivity (43.2%), psychological stress (41.3%), and hypertension (37.7%). Only two (hypertriglyceridemia and high blood pressure) out of the six factors considered in the MFSRS were rated among the first 10 most impactful risks by the SIREN. There was a weak correlation between the total scores on the MFSRS and the SIREN (rho = 0.39; p < 0.01) suggesting that the two ratings were discordant.

CONCLUSION

There were disagreements between the risk estimates on the SIREN and MFSRS with SIREN having a higher estimate that corresponded with the literature; this may be suggesting a poorer estimation of stroke risks by the MFSRS in an African environment. There is a need for large African-based quality control studies to determine and address these lapses.