Abboud Halim, Sissani Leila, Labreuche Julien, Arauz Antonio, Bousser Marie-Germaine, Bryer Alain, Chamorro Angel, Fisher Marc, Ford Ian, Fox Kim M, Hennerici Michael G, Lavados Pablo M, Massaro Ayrton, Mattle Heinrich P, Munoz Collazos Mario, Rothwell Peter M, Steg Philippe Gabriel, Vicaut Eric, Yamouth Bassem, Amarenco Pierre
Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon.
Cerebrovasc Dis. 2017;43(3-4):169-177. doi: 10.1159/000454776. Epub 2017 Feb 15.
Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries.
We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (n = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both p ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; p = 0.07). Key Messages: Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.
中风在很大程度上是可以预防的，因此，更好地了解风险因素是降低阿拉伯国家人群中风发病率及由此产生的疾病负担的关键一步。
我们在两组相似的非心源性缺血性中风患者群体中进行了两项独立分析。第一项分析纳入了3635例短暂性脑缺血发作和脑血管疾病患者结局（OPTIC）登记研究中的患者（随访2年），在基线时收集了常见风险因素和5个社会经济变量（失业状况、农村居住情况、居住在设施齐全的住所、无医疗保险覆盖、低教育水平）。第二项分析纳入了PERFORM试验中的患者（n = 19100，随访2年），在基线时收集了常见风险因素和1个社会经济变量（低教育水平）。主要结局为非致命性中风、非致命性心肌梗死或心血管死亡的复合结局。中风风险因素在阿拉伯国家的患者中更为普遍。阿拉伯国家主要心血管事件（MACE；年龄和性别校正后）的发生率更高（OPTIC研究中为18.5% 对13.3%；PERFORM试验中为18.4% 对9.7%；p均≤０.０００１）。在对风险因素进行校正后，这些结果仍然显著，在对社会经济变量进行进一步校正后，OPTIC研究中的结果有所减弱（风险比1.24；95% CI 0.98 - 1.55；p = 0.07）。关键信息：与非阿拉伯国家的患者相比，生活在阿拉伯国家的缺血性中风患者平均社会经济地位较低，糖尿病患病率高得多，MACE发生率也更高。这一发现部分是由于风险因素的较高患病率，也由于贫困和低教育水平的高患病率。
