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Abstract
Background: Compared with High-Income Countries, stroke in low and middle income countries affects a young and productive age group. Yet, data on risk factors and phenotypic characteristics of stroke in the young are sorely lacking from these regions severely challenging efforts at stroke prevention. Objective: To identify and quantify the unique traditional and emerging risk factors for stroke among young Africans defined as stroke occurring at age <50years old. Methods: Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged >18 years with CT/MRI confirmed stroke. Controls were age-and-gender matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive data were collected using standard instruments. We used conditional logistic regression to estimate odds ratios (OR) and population attributable risks (PAR) with 95% CIs. Results: 515 (24.3%) out of 2,118 cases enrolled were <50 years old. The mean ages of case-control pairs <50 years were 41.0±6.6 and 40.1 ± 6.5 years respectively. Hemorrhagic stroke constituted 52.5%. of the 8 topmost modifiable risk factors for stroke in descending order of PAR were higher educational attainment: (3.98, 1.09-14.46;) hypertension: (31.8, 11.3-88.98 ), dyslipidemia (2.76, 1.33-5.69; ), elevated waist-to-hip ratio:(2.16, 1.00-4.70), stress(2.39, 1.05-5.44), diabetes mellitus :(5.50, 1.93-15.48; 11.9%), cardiac disease(7.67, 1.75-33.60), while green leafy vegetable consumption:(0.32,0.14-0.73) was protective. Interpretation: Cardio-metabolic factors are the key determinants of stroke risk among young Africans. Hemorrhagic stroke frequency is particularly striking in this population. Evidence-based, culturally tailored, interventions targeting these factors are urgently required to curtail the rising burden of stroke among young Africans. Funding: U54-HG007479
Published Version
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