Risk factors for haemorrhagic stroke a case–control study

Abstract

A hospital based pair-matched case-control study was undertaken to identify risk factors for haemorrhagic stroke. The study took place in the Government Medical College Hospital, Nagpur, India, a tertiary care hospital. The study consisted of 166 hospitalised computerised tomography scan proved cases of haemorrhagic stroke (International Classification Diseases 9, 431-432), and an age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. The study included hypertension, serum total cholesterol, alcohol intake, smoking, diabetes mellitus, obesity, physical inactivity, type A personality, use of anticoagulants/antiplatelets, family history of stroke, history of cardiac diseases, past history of transient ischaemic attack, history of claudication and oral contraceptive use in women, as risk factors for haemorrhagic stroke. Bivariate analysis included odds ratio (OR), 95% confidence intervals (CI) for OR and McNemar's chi2 test. Multivariate analysis was carried out by conditional multiple logistic regression analysis. Attributable Risk Percent (ARP), Population Attributable Risk Percent (PARP) and their 95% CI were estimated for significant factors. On conditional multiple logistic regression five risk factors-hypertension (OR=1.9, 95% CI 1.5-2.5), serum total cholesterol (OR=2.3, 95% CI 1.4-4.9), use of anticoagulants and antiplatelet agents (OR=3.4, 95% CI 1.1-10.4), past history of transient ischaemic attack (OR=8.4, 95% CI 2.1-33.6) and alcohol intake (OR=2.1, 95% CI 1.3-3.6) were significant. Estimates of ARP and PARP for these factors confirmed their etiological and preventable role respectively. The current study recognised the significance of five risk factors, which are preventable. These risk factors may be considered for devising effective risk factor intervention strategy for haemorrhagic stroke.