Sarfo Fred Stephen, Adamu Sheila, Obese Vida, Agbenorku Manolo, Opare-Addo Priscilla Abrafi, Ovbiagele Bruce
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Komfo Anokye Teaching Hospital, Kumasi, Ghana.
J Neurol Sci. 2021 May 15;424:117389. doi: 10.1016/j.jns.2021.117389. Epub 2021 Mar 10.
Intracerebral hemorrhage (ICH) stroke constitute up to 40% of incident strokes in Africa. While ICH patients are at high risk for atherosclerotic events, the risk-benefit of anti-atherosclerotic therapies in this patient population is uncertain.
To assess whether utility of statins and/or antithrombotic agents after surviving an ICH correlates with atherosclerotic risk of an observational cohort.
We analyzed data in a stroke registry prospectively collected on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details, including diagnosis of ICH, co-morbidities, and key atherosclerotic risk reduction therapies (statins and anti-platelet drugs). We computed ischemic vascular risk using the Framingham Risk Score (FRS) to classify patients into low, intermediate and high vascular risk.
Of 1101 stroke survivors seen during the period, 244 (22.2%) had ICH. Vascular risk profiles were low (n = 86; 35.2%), intermediate (n = 71; 29.1%) and high (n = 87; 35.7%). Utility of statin use was 76.7% (low risk), 84.5% (intermediate risk), and 87.4% (high risk), p = 0.16 while antiplatelet use trended with atherosclerotic risk being 9.3% (low risk), 25.4% (intermediate risk), and high risk (34.5%), p = 0.0004. Independent factors associated with statin use were hypertension (OR 8.80; 95% CI: 2.34-33.11) and cigarette smoking (OR 0.29; 95% CI: 0.09-0.89) while antiplatelet drug use was associated with age (OR 1.43; 95% CI: 1.06-1.92) and time from index stroke (OR: 1.02; 95% CI: 1.01-1.02).
Approximately two-thirds of ICH survivors in this African sample had intermediate to high risk of future atherosclerotic events. Clinical trials on the timing, safety, and efficacy of statins and antiplatelet drugs among ICH survivors could help better guide risk mitigation in this population.
脑出血（ICH）性卒中占非洲新发卒中的40%。虽然ICH患者发生动脉粥样硬化事件的风险很高，但在这一患者群体中抗动脉粥样硬化治疗的风险效益尚不确定。
评估ICH存活者使用他汀类药物和/或抗血栓药物的情况是否与一个观察性队列的动脉粥样硬化风险相关。
我们分析了2018年1月至2020年3月在加纳一家门诊连续就诊的卒中幸存者前瞻性收集的卒中登记数据。我们收集了基线人口统计学和临床细节，包括ICH诊断、合并症以及关键的动脉粥样硬化风险降低治疗（他汀类药物和抗血小板药物）。我们使用弗明汉风险评分（FRS）计算缺血性血管风险，将患者分为低、中、高血管风险组。
在此期间就诊的1101名卒中幸存者中，244名（22.2%）有ICH。血管风险概况为低风险（n = 86；35.2%）、中风险（n = 71；29.1%）和高风险（n = 87；35.7%）。他汀类药物使用情况为低风险组76.7%、中风险组84.5%、高风险组87.4%，p = 0.16；而抗血小板药物使用情况随动脉粥样硬化风险呈趋势变化，低风险组为9.3%、中风险组为25.4%、高风险组为34.5%，p = 0.0004。与他汀类药物使用相关的独立因素是高血压（OR 8.80；95%CI：2.34 - 33.11）和吸烟（OR 0.29；95%CI：0.09 - 0.89），而抗血小板药物使用与年龄（OR 1.43；95%CI：1.06 - 1.92）和首发卒中后的时间（OR：1.02；95%CI：1.01 - 1.02）相关。
在这个非洲样本中，约三分之二的ICH幸存者未来发生动脉粥样硬化事件的风险为中到高。关于ICH幸存者使用他汀类药物和抗血小板药物的时机、安全性和疗效的临床试验有助于更好地指导该人群的风险降低。
