Abstract
Objective: To determine risk factors in different pathogenic subtypes of ischemic stroke in Tashkent hospital registry and to compare with the data of other stroke registers.Design: Prospective observational study.Participants: 300 adults aged 18 years or over who suffered first-ever acute ischemic stroke, of them, the data of 100 patients with atherothrombotic, lacunar and cardioembolic strokes were analyzed.Main outcome measures: Mathematically significant differences and not significant differences but interesting from other point of view. Categorical variables are expressed as frequencies and percentages. Differences were regarded as statistically significant when the P value was less than 0.05 (P<0.05).Results: Of 100 patients with acute first-ever ischemic stroke at the median age of 62.63±4.68 (interquartile range 25-92) years, 57% were men and 43% were women. Depending on aetiology and stroke subtype, all the patients were divided into three groups: 42 patients with atherothrombotic stroke, 41 – with lacunar stroke, and 17 patients with cardioembolic stroke. Atherothrombotic stroke developed often in people over 60 years old, while lacunar stroke prevailed at the younger age. Stroke cases increased in people over 51 years old. Although men were more likely to suffer strokes than women, stroke incidence was equal in both sexes with increasing of age (over 60 years old), especially in atherothrombotic stroke, testifying to that women live longer. Combination of cerebral atherosclerosis and hypertension was the most significant risk factor for stroke. Atherosclerosis was the main aetiological factor for ischemic stroke, independently of its pathogenic heterogeneity. Diabetes mellitus was an independent risk factor for all stroke subtypes, which in most cases worsened the course and outcome of stroke. Hypertension was the leader aetiological factor for lacunar stroke. In these patients, we also should consider the presence of other risk factors, e.g. severe large vessel obstructions, se-triglycerol ≥2 mmol/L, etc. Cardioembolic stroke developed mainly because of cardiac thrombosis and valve pathology, which were often associated with chronic diseases of other organs, worsening the course and outcome of stroke. Despite of high prevalence of myocardial infarction in men, women were more likely to develop cardioembolic stroke.Conclusions: This study found simultaneous influence of many risk factors (multifactorial disease) in the development of ischemic stroke. The more course and influence of the underlying disease and risk factor, the higher stroke risk and severity, especially in the absence or inadequate previous therapy of underlying disease before the stroke index. We have noted a high prevalence of under-diagnosis of vascular risk factors at levels of primary and secondary care. We recommend for improved public awareness of vascular risk factors and better diagnostic and treatment facilities aimed at addressing those factors at levels of primary and secondary healthcare. Larger population-based studies may provide additional data on stroke incidence and outcome among Uzbeks.
Highlights
Stroke cases increased in people over 51 years old
We have noted a high prevalence of under-diagnosis of vascular risk factors at levels of primary and secondary care
We recommend for improved public awareness of vascular risk factors and better diagnostic and treatment facilities aimed at addressing those factors at levels of primary and secondary healthcare
Summary
In Uzbekistan, the annual number of new stroke cases is about 209/100,000 inhabitants (Azhieva, 2008; Gafurov, 2009; Sagatov et al, 2011), while this rate is 130 in France, 155 in Germany, 170 in the UK, 223 in Spain, 400 in Hungary (Bonita, 1992; Bogousslavsky, 2000; Aszalos et al, 2002), 231 in Ukraine, 500 in Russia, and 795 in the USA (AHA computation based on the latest available data) (calculated from overall incidence of stroke) (Bonita, 1992; Vereschagin et al, 2002; Feigin, 2005; Suslina et al, 2009; Go et al, 2013). Disability affects 42.2% of stroke survivors, and no more 10.2% stroke patients could save their employability
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