Abstract
Background. Stroke is a multifactorial disease with various clinical presentations ruled out by modifiable and non-modifiable risk factors (RF). Multiple vascular and behavioural factors lead to an increased risk of ischemic stroke, as they can differ in various countries. Understanding those factors may result in the implementation of strategies for screening, prevention, and reducing the overall risk of stroke. There is a lack of contemporary information regarding the RF for ischemic stroke (IS) in Bulgaria. Objective. We aimed to determine the major potential RF for ischemic stroke in the Bulgarian population. Material and methods. A prospective hospital-based case-control study was conducted between July 1, 2019, and June 30, 2020, at a tertiary care referral center for neurological disorders. We included cases with first-ever and recurrent stroke and stroke-free controls. Association between RF and IS was expressed in odds ratio (OR) through a 95% confidence interval (CI). Statistical significance was defined as a p-value of 0.05 or less. Results. Overall 150 cases and 100 stroke-free participants were included. All risk factors were more prevalent in the case-group, except for dyslipidemia which had an inverse association with IS risk. The most significant RF for IS consisted of hypertension (OR, 28.78; 95% CI, 6.67 – 124.15) heart failure (OR, 15.25; 95% CI, 6.29-36.97), atrial fibrillation (OR, 11.29; 95% CI, 3.92-32.51), ischemic heart disease (OR, 5.83; 95% CI, 2.81-12.12), diabetes mellitus (OR, 2.65; 95% CI, 1.28-5.49), daily alcohol abuse with concentrate (OR, 9.39; 95% CI, 1.21-73.00) and current smoking (OR, 1.82; 95% CI, 1.00-3.32). Conclusions. The results of this study confirm the significant contribution of modifiable RF, both behavioral and related to medical conditions. Early detection and management of the major stroke RF may result in lower stroke incidence. Therefore, implementations of strategies for screening and prevention are needed to reduce the overall risk of stroke.
Highlights
Stroke is a socially significant disease, ranked as the second most common cause of death and chronic disability in patients who survived the acute stage
The present study aims to identify, in a hospital-based case-control study, the prevalence and the relative importance of various major modifiable risk factors contributing to ischemic stroke in the Bulgarian population
From all the factors we studied, hypertension is associated with the highest risk of ischemic stroke - 28.78 times
Summary
Stroke is a socially significant disease, ranked as the second most common cause of death and chronic disability in patients who survived the acute stage. According to The Global Burden of Diseases Study from 2016, about 38,000 people get a stroke in Bulgaria every year, and about 206,000 people live in the country with the consequences of a stroke [3]. Multiple vascular and behavioural factors lead to an increased risk of ischemic stroke, as they can differ in various countries. Understanding those factors may result in the implementation of strategies for screening, prevention, and reducing the overall risk of stroke. We included cases with first-ever and recurrent stroke and stroke-free controls. Overall 150 cases and 100 stroke-free participants were included. Implementations of strategies for screening and prevention are needed to reduce the overall risk of stroke
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