Albitar Mhd Mustafa, Maya Subhia, Al Ashabia Khaled Kalalib, Hamzeh Ghassan, Kakaje Ameer
Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Head of the Neurology Department, Al Assad University Hospital, Damascus, Syrian Arab Republic.
Sci Rep. 2025 Jan 2;15(1):115. doi: 10.1038/s41598-024-83569-z.
Stroke is the second-leading cause of death worldwide, including in Syria, and the third-leading cause of death and disability combined. With approximately 90% of strokes worldwide linked to modifiable risk factors, identifying and quantifying these factors within a specific population is essential for effective prevention. This is the first study to investigate primary risk factors for stroke in Syria. This study included the six primary stroke centres across four major cities in Syria. Data was collected through case files and a questionnaire answered by the cases or their proxies through personal interviews, as well as selected controls. A total of 411 cases were recruited, comprising 363 ischemic strokes (IS) and 48 haemorrhagic strokes, and with a matched ratio of 1:1 for age and sex. IS was significantly associated with multiple chronic conditions including atrial fibrillation AF [AOR 5.04 (2.64-9.62)], high body mass index (overweight [AOR 2.09 (1.28-3.40)], obesity [AOR 4.17 (2.32-7.50)]), hypercholesterolemia [AOR 2.10 (1.34-3.28], hypertension HTN [AOR 1.83 (1.23-2.73)], and diabetes mellitus DM [AOR 1.79 (1.18-2.71)]. Moreover, several lifestyle risk factors contributed to IS: Alcohol consumption [AOR 4.80 (1.72-13.41)], a diet lacking fruits and vegetables [AOR 2.04 (1.28-3.23)], and low physical activity PA [AOR 1.75 (1.01-2.86)]. Notably, over 40% of the population exhibited medication nonadherence. IS showed no significant association with cigarette smoking, heart failure (HF), ischemic heart disease (IHD), or a family history of stroke (p > 0.05). In contrast, haemorrhagic stroke was linked to higher BMI, HTN, DM, and AF (p < 0.05), but not to hypercholesterolemia, cigarette smoking, IHD, or HF (p > 0.05). This first nationwide multicentre case-controlled study in Syria identified critical modifiable risk factors for stroke, including hypertension, diabetes, atrial fibrillation, and obesity, with high rates of medication non-adherence, especially among hypertensive patients, complicating stroke risk. These findings underscore the urgent need for targeted health interventions promoting lifestyle modifications, medication adherence, and public health policies tailored to Syria's current resource-limited context to reduce the stroke burden and improve population health.
中风是全球第二大致死原因，在叙利亚亦是如此，且是致死和致残合并的第三大原因。全球约90%的中风与可改变的风险因素有关，在特定人群中识别和量化这些因素对于有效预防至关重要。这是第一项调查叙利亚中风主要风险因素的研究。该研究纳入了叙利亚四个主要城市的六个主要中风中心。数据通过病例档案以及病例或其代理人通过个人访谈回答的问卷收集，同时也收集了选定的对照数据。共招募了411例病例，包括363例缺血性中风（IS）和48例出血性中风，年龄和性别匹配比例为1:1。IS与多种慢性疾病显著相关，包括心房颤动AF [调整后比值比（AOR）5.04（2.64 - 9.62）]、高体重指数（超重 [AOR 2.09（1.28 - 3.40）]、肥胖 [AOR 4.17（2.32 - 7.50）]）、高胆固醇血症 [AOR 2.10（1.34 - 3.28）]、高血压HTN [AOR 1.83（1.23 - 2.73）]以及糖尿病DM [AOR 1.79（1.18 - 2.71）]。此外，一些生活方式风险因素也导致了IS：饮酒 [AOR 4.80（1.72 - 13.41）]、缺乏水果和蔬菜的饮食 [AOR 2.04（1.28 - 3.23）]以及低体力活动PA [AOR 1.75（1.01 - 2.86）]。值得注意的是，超过40%的人群存在药物治疗不依从情况。IS与吸烟、心力衰竭（HF）、缺血性心脏病（IHD）或中风家族史无显著关联（p > 0.05）。相比之下，出血性中风与较高的BMI、HTN、DM和AF相关（p < 0.05），但与高胆固醇血症、吸烟、IHD或HF无关（p > 0.05）。叙利亚的这项首次全国性多中心病例对照研究确定了中风的关键可改变风险因素，包括高血压（HTN）、糖尿病（DM）、心房颤动（AF）和肥胖，药物治疗不依从率很高，尤其是高血压患者，这使中风风险更为复杂。这些发现强调迫切需要进行有针对性的健康干预，以促进生活方式改变、药物治疗依从性，并制定适合叙利亚当前资源有限情况的公共卫生政策，以减轻中风负担并改善人群健康。
