Prevalence Of Stroke Risk Factors Research Articles

Abstract 277: Examining the Impact of Area Deprivation on Endovascular Stroke Therapy Access

Intro & Background Equitable access to healthcare is heavily impacted by socioeconomic factors, however, the effects of such disparities in accessing life‐saving stroke treatments remain incompletely characterized. Here we explore the impact of disparities on access to endovascular treatments for large vessel occlusion acute ischemic stroke (LVO AIS). Methods & Materials From our prospectively maintained multi‐hospital registry of four Comprehensive Stroke Centers, we identified patients 18 years or older with LVO AIS from January 2019‐ June 2020. Patient addresses and zip codes were matched to census‐tract level area deprivation index (ADI) scores obtained from Neighborhood Atlas (U. Of Wisconsin). ADI is a validated neighborhood‐level measure that utilizes variables such as income, education, and employment to quantify the level of deprivation in an area. The primary outcome was utilization of endovascular thrombectomy (EVT) by ADI quartile, adjusted for age, ASPECTS, and NIHSS, and was determined using multivariable logistic regression and expressed as OR [95% CI]. Results Among 637 patients with LVO AIS, the median age was 68, 46% were female, 64% were white, 28% were black, and 19% identified as Hispanic. Median ADI was 57 IQR [32‐78]. Notably, non‐Hispanic Black (NH‐Black) patients had the largest proportion 48.9% (N=66) of those with the highest ADI scores ranging from 79‐100. Comparatively, non‐Hispanic White (NH‐White) patients represented the largest population 67.7% (N=84), of those with the lowest ADI scores of ≤31. Greater ADI scores were associated with a higher prevalence of stroke risk factors, including hypertension, type 2 diabetes, prior stroke, and hyperlipidemia. NIHSS, pMRS, ASPECTS, final TICI scores, 90‐day disability outcomes, and discharge disposition were comparable across the ADI quartiles. In the univariable analysis, patients with AIS LVO in greater ADI neighborhoods were less likely to undergo EVT (61% vs 67% vs 61% vs. 50%, ADI quartiles least to greatest respectively, p=0.01). In the multivariable analysis adjusted for age, ASPECTS, and NIHSS [1], higher ADI regions were less likely to receive EVT intervention (OR 0.73, 95% CI (0.59‐0.91), p<0.01). Conclusion Patients residing in disadvantaged neighborhoods (greater ADI regions) may have reduced access to EVT, despite comparable acute stroke presentation symptoms. These findings are consistent with prior studies demonstrating poorer health outcomes in these populations.

Racial disparities in functional outcomes following mechanical thrombectomy in a cohort of patients with ischemic stroke

BackgroundNon-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following...

Demographic and Clinical Characteristics of a Sample of Egyptian Stroke Patients Admitted to the Stroke Unit of a University Hospital

Background Stroke is a catastrophic life-changing event which influences not only stroke patients but also their families and care givers. The recommended treatments for ischemic stroke that are guideline include systematic supportive care in a stroke unit or stroke center is still deficient. Aim of the Work To present the demographic profile, and clinical characteristics of a sample of Egyptian patients, with acute ischemic stroke, admitted to stroke unit in Ain Shams University Hospital, and compare to other ethnic groups reported in other studies. Subjects and Methods This is a retrospective study, derived from the database of stroke patients admitted to the stroke unit in Ain Shams University Hospital and Ain shams specialized hospital in the period from (the first of January 2016 to 30th of March 2020). Results A favorable early outcome (mRS≤2) showed high significant correlation with male gender, younger age and less prevalence of AF, and a significant correlation with less prevalence of hypertension and dyslipidemia. Conclusion The burden of stroke and high prevalence of stroke risk factors in Egypt are alarming. Research is critically needed to fully evaluate the burden of stroke in Egypt, and organization of stroke care locally and nationally requires coordinated efforts by multiple stakeholders. The most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions.

Clinical profiles, comorbidities, and treatment outcomes of stroke in the medical ward of Dessie comprehensive specialized hospital, Northeast Ethiopia; a retrospective study

Background:Undoubtedly, stroke is expanding as a global public health issue. Stroke-related deaths are attributable to modifiable risk factors. A demographic shift in Ethiopia increased the prevalence of stroke risk factors. Furthermore, there is limited relevant information available about stroke. Therefore, the current study sought to evaluate the clinical profiles, comorbidities, and treatment outcomes of stroke in the medical ward of Dessie comprehensive specialized hospital.Methods:A retrospective cross-sectional study design was employed among stroke patients. The study included medical records with complete patient information and a stroke diagnosis that had been verified using imaging techniques. Using simple random sampling, 344 medical records were selected, 312 of which met the requirements for inclusion. The frequency and percentage of sociodemographic characteristics and other variables were described using descriptive statistics.Results:The patients were 59.2 ± 14.6 years old on average. About 14.7% of the study participants were chat chewers. Of stroke victims, about 52.2% had sensory loss and limb weakness. Nearly 44.9% of the patients had hemiplegia or hemiparesis when they were first seen, and 25.3% were unconscious. Hypertension (63.1%), atrial fibrillation (15.1%), and structural heart diseases (12.5%) were the frequently seen co-morbidities in stroke patients. About 35.8% of the patients had fully recovered and were released go from the hospital without suffering any repercussions. However, hospital deaths from stroke accounted for 21.8% of cases. Stroke fatalities usually involved hypertension, atrial fibrillation, and structural heart disorders.Conclusion:Sensory deficits, limb weakness, and mentation loss were all common clinical presentations in stroke patients. In particular, hypertension, atrial fibrillation, and structural heart diseases were commonly seen as comorbidities in stroke patients. Stroke mortality was high in the hospital. Thus, establishing promotive, preventive, curative, and rehabilitative strategies is indispensable.

Barriers to stroke prevention in Atrial Fibrillation: Insights from the global anticoagulation Roundtable.

Atrial fibrillation (AF) accounts for one-quarter of the global ischemic stroke burden. Population growth and an increasing prevalence of stroke risk factors underscores the critical need to recognize and address the worldwide crisis in underutilization of antithrombotic therapy for patients with AF. Failure to address key patient, clinician, and societal gaps in AF care will result in a worldwide increase in stroke-related morbidity and mortality while overwhelming global healthcare systems. The failure to adhere to evidence-based guideline recommendations for stroke prevention in AF reflects a critical gap in implementation of best clinical practice among providers and healthcare systems. Globally, these include inadequate provider education, limited public awareness, underdiagnosis, and underutilization of treatments, including antithrombotic therapy. In specific regions, efforts are further complicated by availability of specific medications, variation in drug metabolism across racial and ethnic populations, socioreligious considerations, and lack of universally available electronic health records. Efforts are needed at both global and regional levels to address key barriers to evidence-based care for patients with AF. Investing in clinical tools and teams that improve stroke prevention for patients with AF will likely improve population health.

Prevalence and factors associated with stroke risk factors in an urban community of Parakou, Northern Benin, 2016.

Sub-Saharan Africa faces a heavy burden of stroke due to the growth of its risk factors. We aimed to estimate the prevalence of stroke risk factors and identify the factors associated with metabolic risk factors in the district of Titirou, in Parakou (northern Benin) in 2016. A cross-sectional study was conducted. It included people aged at least 15 years, living in Titirou for at least 6 months, and who had given their written consent to participate in the study. A door-to-door survey was performed from 15 march to 15 July 2016 in each neighborhood until the pre-determined number was reached. Sociodemographic data, medical histories, anthropometric and blood pressure measures were recorded using the WHO STEPS approach. The prevalence of stroke risk factors was calculated, and a multivariable logistic regression was done to identify the factors associated with metabolic risk factors for stroke. A total of 4671 participants were included with a mean age of 27.7±12.9 years and a sex ratio of 0.98. Concerning the behavioral risk factors for stroke, 17.2% were alcohol consumers, 3.5% were smokers, 21.5% had low fruit and vegetable intake, and 51.1% had low physical activity practice. The prevalence of metabolic risk factors for stroke was respectively of 8.7% for obesity, 7.1% for high blood pressure, 1.7% for self-reported diabetes, and 2.2% for dyslipidemia. Age (p<0.001), sex (p<0.001), marital status (p<0.001) and professional occupation (p = 0.010) were associated with obesity. Age was also associated with high blood pressure (p<0.001) and diabetes (p<0.001). Dyslipidemia varied according to smoking (p = 0.033) and low physical activity practice (p = 0.003). The study revealed a significant prevalence of some stroke risk factors. Targeted local interventions for primary prevention of stroke should be promoted in this community.

Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales

Introduction: Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). Methods: This was a 10-year retrospective analysis (2011–2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. Results: The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/100,000/year). In SWS, 56.6% of people were overseas-born compared to 29.8% for NSW. The age-standardized rate of TIA/stroke for Polynesian-born people was more than double that of Australian-born people (p < 0.001). Hypertension (33 [SWS] vs. 27/100,000/year [NSW]) and T2DM (36 [SWS] vs. 26/100,000/year [NSW]) were the most common risk factors with rates >50/100,000/year (hypertension) and >80/100,000/year (T2DM) for people born in Polynesia, Melanesia, and Central America. Rates of T2DM, AF, and obesity for Polynesian-born people were over threefold greater than people born in Australia. Discussion/Conclusion: Greater rates of TIA/stroke were observed in specific CALD communities, with increased rates of cerebrovascular risk factors. Culturally specific, targeted interventions may bridge health inequalities in cerebrovascular disease.

Trends in the Incidence and Risk Factors of Pregnancy-Associated Stroke.

Pregnancy is a female-specific risk factor for stroke. Although pregnancy-associated stroke (PAS) is a rare event, PAS leads to considerable maternal mortality and morbidity. It is estimated that 7.7–15% of all maternal deaths worldwide are caused by stroke and 30–50% of surviving women are left with persistent neurological deficits. During last decade, several studies have reported an increasing incidence of PAS. The objective of this review is to summarize studies on time trends of PAS in relation to trends in the prevalence of stroke risk factors in pregnant women. Seven retrospective national healthcare register-based cohort studies from the US, Canada, UK, Sweden, and Finland were identified. Five studies from the US, Canada, and Finland reported an increasing trend of PAS. Potential biases include more sensitive diagnostics and improved stroke awareness among pregnant women and professionals toward the end of the study period. However, the concurrent increase in the prevalence of several stroke risk factors among pregnant women, particularly advanced age, hypertensive disorders of pregnancy, diabetes, and obesity, indicate that the findings are likely robust and should be considered seriously. To reduce stroke in pregnancy, increased awareness among all medical specialties and pregnant women on the importance of risk-factor management during pregnancy and stroke symptoms is necessary. Important preventive measures include counseling for smoking cessation and substance abuse, treatment of hypertensive disorders of pregnancy, use of aspirin in women at high risk for developing preeclampsia, and antithrombotic medication and pregnancy surveillance for women with high-risk conditions. Epidemiological data from countries with a high risk-factor burden are largely missing. National and international registries and prospective studies are needed to increase knowledge on the mechanisms, risk factors, management, and future implications for the health of women who experience this rare but devastating complication of pregnancy.

SEX-SPECIFIC DIFFERENCES IN STROKE EPIDEMIOLOGY IN LUSAKA, ZAMBIA

<h3>Introduction</h3> Sex-specific characteristics of stroke and access to post-stroke care data remain limited in sub-Saharan Africa. <h3>Objective</h3> Evaluate sex-specific stroke risk factors and characteristics of stroke care among adults with stroke in Zambia. <h3>Methods</h3> We retrospectively collected demographic, clinical, laboratory and imaging results, and in-hospital mortality for consecutive adults admitted with stroke to University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. Strokes were classified as ischemic or hemorrhagic based on CT appearance, and as unknown if neuroimaging was unavailable. Descriptive statistics were compared by sex among adults with stroke using t-tests for continuous variables and chi-squared analysis for categorical variables. <h3>Results</h3> Women constituted 62% (n=200) of the cohort, were older (61±19 years vs 57±16 years, p=0.06) and had lower rates of hemorrhagic stroke (22% vs 37%, p=0.001). Hypertension (84% vs 74%, p=0.04) and diabetes (19% vs 13%, p=0.04) were more frequent in women. Several delays exist between stroke onset and care for women, including lack of CT imaging during hospitalization (82% vs 94% men, p=0.002), and, among those with neuroimaging, a trend towards longer delays in obtaining imaging with 69% of women having ≥1 day delay between admission and CT imaging compared to 53% of men (p=0.10). <h3>Discussion</h3> Females with stroke have fewer hemorrhagic strokes and higher prevalence of stroke risk factors. Women experience delays in acquiring post-stroke care, including in obtaining CT imaging, compared to men. Our data necessitates further study of social and socioeconomic factors that may result in women having reduced access to quality acute stroke and preventative care.

Abstract TP180: Secular Trends For Demographics, Characteristics, Management, And Clinical Outcome Of Young Adults With Acute Ischemic Stroke.

Background: The incidence of stroke in young adults is increasing with the growing prevalence of stroke risk factors among young adults over the last decades. However, studies on secular trends in the young-age stroke population are scarce. Methods: We extracted data of acute ischemic stroke (AIS) patients aged 18-50 (n=7053; age, 43±6; male, 72%) from the multicenter stroke registry in South Korea. Demographics, risk factors, stroke characteristics, management, and clinical outcomes in young adults with AIS were summarized according to calendar year (2008-2019). Trends analysis was conducted using a linear regression model for continuous variables and the Mann-Kendall trend test for categorical variables. Results: There was no significant change between 2008 and 2019 in the proportions of young adults among female patients (7.1% to 7.0%, p=0.44). However, the proportions of young adults within male patients tended to decrease (12.4% to 10.7%; p=0.001) The prevalence, and awareness of risk factors were unchanged during the study period. Regarding stroke subtypes, there was a significant increase in other determined etiology (8% to 20%; p&lt;0.001) and a tendency to decrease in large artery atherosclerosis (26% in 2008; 34% in 2009 to 26% in 2019; p=0.28). The endovascular thrombectomy (EVT) rate increased (2% to 8%; p&lt;0.001), but the intravenous thrombolysis rate (8.8% to 10.6%) and door-to-needle time (38 to 36 min) did not change. Use of dual antiplatelet (DAPT; 29% to 55%; p=&lt;0.001) increased and direct oral anticoagulants (DOACs) in patients with atrial fibrillation tended to increase (11.7% in 2013 to 44.8% in 2019; p=0.07; DOAC began to be used in 2013 in Korea). However, the use of anticoagulants among young adult patients having atrial fibrillation tended to decrease (80% to 66%; p=0.054). Clinical outcomes, including a 3-month modified ranking scale 0-2 (84.6% to 85.2%), 1-year mortality (2.8% to 2.4%), and stroke recurrence rate (4.5 to 5.6%), did not improve during the study period. Conclusions: Among young adults with ischemic stroke, the EVT rate and use of DAPT or DOACs increased. Still, awareness of risk factors, door-to-needle time, and anticoagulation for atrial fibrillation required more attention to improve clinical outcomes.

Family History of Stroke is Associated with Greater Prevalence of Certain Risk Factors and Self-Reported Stroke Symptoms

ObjectivesFamily history of stroke increases stroke risk, however mechanisms underlying this association remain unclear. We investigated whether family history of stroke is related to increased prevalence of stroke risk factors, unhealthy behaviors and self-reported stroke symptoms in middle-aged adults. Materials and MethodsIn a cross-sectional study conducted from November 2018 to January 2021 in 100 primary care facilities in Poland we evaluated adults aged 40-65 years (n = 2207, women 57.4%, median age 55 years) for stroke risk factors, healthy behaviors, family history of stroke, self-reported stroke symptoms and stroke knowledge using structured questionnaires. Patients were categorized based on family history of stroke defined as ≥1 first-degree relative with documented stroke. ResultsFamily history of stroke was reported by 571 (25.9%) individuals who were older (median age 56 vs. 54 years, p = 0.00001) and after adjustment for age more frequently suffered from hypertension (61.5% vs. 53.7%, p = 0.024) and prior transient ischemic attack (2.1% vs. 0.9%, p = 0.019), but not other risk factors. However, they were less obese (34.5% vs. 39.1%, p = 0.03). Women, but not men, with family history of stroke (n = 339, 26.8%) had greater prevalence of atrial fibrillation (7.4% vs. 3.9%, p = 0.037). Family history of stroke was associated with higher prevalence of any self-reported stroke symptom (32.9% vs. 23.2%, p < 0.00001), but not with unhealthy dietary behaviors or low level of knowledge about stroke. ConclusionsFamily history of stroke is associated with greater prevalence of certain risk factors and self-reported stroke symptoms, which indicates the need for closer surveillance of middle-aged individuals at risk.

Rural/urban differences in the prevalence of stroke risk factors: A cross-sectional analysis from the REGARDS study.

We previously described the magnitude of rural-urban differences in the prevalence of stroke risk factors and stroke mortality. In this report, we sought to extend the understanding of rural-urban differences in the prevalence of stroke risk factors by using an enhanced definition of rural-urban status and assessing the impact of neighborhood socioeconomic status (nSES) on risk factor differences. This analysis included 28,242 participants without a history of stroke from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants were categorized into the 6-level ordinal National Center for Health Statistics Urban-Rural Classification Scheme. The prevalence of stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy, and heart disease) was assessed across the rural-urban scale with adjustment for demographic characteristics and further adjustment for nSES score. Hypertension, diabetes, and heart disease were more prevalent in rural than urban regions. Higher odds were observed for these risk factors in the most rural compared to the most urban areas (odds ratios [95% CI]: 1.25 [1.11-1.42] for hypertension, 1.15 [0.99-1.33] for diabetes, and 1.19 [1.02-1.39] for heart disease). Adjustment for nSES score partially attenuated the odds of hypertension and heart disease with rurality, completely attenuated the odds of diabetes, and unmasked an association of current smoking. Some of the higher stroke mortality in rural areas may be due to the higher burden of stroke risk factors in rural areas. Lower nSES contributed most notably to rural-urban differences for diabetes and smoking.

Rural-urban differences in stroke risk

Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.

Risk Factors and Incidence of Acute Ischemic Stroke: A Comparative Study Between Young Adults and Older Adults.

IntroductionApproximately 5-10% of strokes occur in adults of less than 45 years of age. The rising prevalence of stroke risk factors may increase stroke rates in young adults (YA). We aimed to compare risk factors and outcomes of acute ischemic stroke (AIS) among YA.MethodsAdult hospitalizations for AIS and concurrent risk factors were found in the Nationwide Inpatient Sample database. Weighted analysis using chi-square and multivariable survey logistic regression was performed to evaluate AIS-related outcomes and risk factors among YA (18-45 years) and older patients.ResultsA total of 4,224,924 AIS hospitalizations were identified from 2003 to 2014, out of which 198,378 (4.7%) were YA. Prevalence trend of YA with AIS showed incremental pattern over time (2003: 4.36% to 2014: 4.7%; pTrend<0.0001). In regression analysis, the risk factors associated with AIS in YA were obesity (adjusted odds ratio {aOR}: 2.26; p<0.0001), drug abuse (aOR: 2.56; p<0.0001), history of smoking (aOR: 1.20; p<0.0001), infective endocarditis (aOR: 2.08; p<0.0001), cardiomyopathy (aOR: 2.11; p<0.0001), rheumatic fever (aOR: 4.27; p=0.0014), atrial septal disease (aOR: 2.46; p<0.0001), ventricular septal disease (aOR: 4.99; p<0.0001), HIV infection (aOR: 4.36; p<0.0001), brain tumors (aOR: 7.89; p<0.0001), epilepsy (aOR: 1.43; p<0.0001), end stage renal disease (aOR: 2.19; p<0.0001), systemic lupus erythematous (aOR: 3.76; p<0.0001), polymyositis (aOR: 2.72; p=0.0105), ankylosis spondylosis (aOR: 2.42; p=0.0082), hypercoagulable state (aOR: 4.03; p<0.0001), polyarteritis nodosa (aOR: 5.65; p=0.0004), and fibromuscular dysplasia (aOR: 2.83; p<0.0001).ConclusionThere is an increasing trend in AIS prevalence over time among YA. Both traditional and non-traditional risk factors suggest that greater awareness is needed, with prevention strategies for AIS among young adults.

Abstract P602: Stroke Risk Factors Among the Young Over Time in the GCNKSS

Background: Data from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) have demonstrated stable or increasing stroke incidence rates in young adults with differences by sex and race, suggesting the need for targeted approaches to stroke prevention in the young. We aimed to describe trends over time in prevalence of stroke risk factors among adults ages 20-54 with stroke by sex and race. Methods: Cases of incident stroke (IS, ICH, SAH) occurring in those 20-54 years old and living in a 5-county area of southern Ohio/northern Kentucky were ascertained during 5 study periods (1993-1994, 1999, 2005, 2010, 2015). All physician-adjudicated inpatient events and a sampling of outpatient events were included, excluding nursing home events. Data on risk factors (hypertension, diabetes, obesity (BMI≥30), and high cholesterol) diagnosed prior to stroke were abstracted from medical records, and prevalence of each risk factor was reported over time in race/sex groups. Trends over time were examined using the Cochran-Armitage test. Results: Over the 5 study periods, 1204 incident strokes were included; 49% were women, 33% were black, and mean age was 46 (SD 7) years. Premorbid hypertension increased over time in Black women (48% in 1993/4 to 76% in 2015, p=0.005) but not in any other race/sex group (all p&gt;0.05). Premorbid high cholesterol increased significantly in all race/sex groups (Figure, all p&lt;0.05) except for White men (p=0.06). There were no significant trends over time in pre-stroke diagnoses of diabetes or obesity in any of the race/sex groups (Figure). Conclusions: Among patients aged 20-54 with incident stroke in a large population-based study, the change in the prevalence of hypertension and high cholesterol differed by sex and race, while obesity and diabetes were stable over time in all race/sex groups. Future research is needed to address risk factor control at a population level and to understand the role of undiagnosed pre-stroke risk factors in the young.

ISCHEMIC STROKE REGISTRY IN EGYPT: HOSPITAL BASED STUDY

Background: Stroke is defined by the World Health Organization(WHO) as ‘a clinical syndrome consisting of rapidly developing clinical signs of focal (or sometimes global) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin. Objective: To study the pattern of ischemic stroke subtypes in a sample Egyptian patients, common risk factor profiles and management methods. Patients: A retrospective study was conducted on 321 patients who were admitted to Al-Azhar University Hospitals and Nasser Institute with a main primary diagnosis of acute ischemic stroke during the period from January 2017 until December 2018. Results: Small vessel strokes were the most common accounting for 51.1% of all patients, followed by large vessel getting affected 24% of the cases. Cardio embolic stroke was present in 20.8%of the cases, Hypertension was the most prevalent risk factor among patients accounting for 61.1%, diabetes (49.5%), obesity (38.6%), and smoking (32.1%). A significant difference in stroke severity among stroke patients regarding smoking status was found in univariate analysis and obesity. Multivariate analysis using multiple linear regressions showed that the relationship with obesity was significant. Conclusion: In spite of the high prevalence of stroke risk factors among the study patients, the power wasn’t enough to show any association with stroke severity except for smoking and obesity, where smokers and obese patients are more likely to have higher stroke severity.

ISCHEMIC STROKE REGISTRY IN EGYPT: HOSPITAL BASED STUDY

Background: Stroke is defined by the World Health Organization(WHO) as ‘a clinical syndrome consisting of rapidly developing clinical signs of focal (or sometimes global) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin. Objective: To study the pattern of ischemic stroke subtypes in a sample Egyptian patients, common risk factor profiles and management methods. Patients: A retrospective study was conducted on 321 patients who were admitted to Al-Azhar University Hospitals and Nasser Institute with a main primary diagnosis of acute ischemic stroke during the period from January 2017 until December 2018. Results: Small vessel strokes were the most common accounting for 51.1% of all patients, followed by large vessel getting affected 24% of the cases. Cardio embolic stroke was present in 20.8%of the cases, Hypertension was the most prevalent risk factor among patients accounting for 61.1%, diabetes (49.5%), obesity (38.6%), and smoking (32.1%). A significant difference in stroke severity among stroke patients regarding smoking status was found in univariate analysis and obesity. Multivariate analysis using multiple linear regressions showed that the relationship with obesity was significant. Conclusion: In spite of the high prevalence of stroke risk factors among the study patients, the power wasn’t enough to show any association with stroke severity except for smoking and obesity, where smokers and obese patients are more likely to have higher stroke severity.

A cross-sectional analysis of 2017 stroke symptoms recognition at the US regional level

Stroke symptom recognition is critical in reducing time to treatment, but it is not known whether the increased support for stroke education programs during the last several years has led to an improvement in regional stroke symptom recognition levels since they were last assessed in the mid-2010s. We used the most current estimates of recognition from the 2017 National Health Interview Survey to examine regional recognition levels for individual stroke symptoms and correct identification of all five stroke symptoms. Recognition of individual stroke symptoms was ≥76% in all regions, but correct identification of all stroke symptoms was lower ranging from 68.8 to 70.2%. Recognition of sudden numbness or weakness of face, arm, or leg, especially on one side (Northeast: 94.9%, Midwest: 95.8%, South: 93.8%, West: 94.5%) was the highest and recognition of sudden headache with no known cause (Northeast: 77.6%, Midwest: 76.4%, South: 77.7%, West: 76.5%) was the lowest for all regions. We observed similar stroke symptom recognition levels in each US region with little improvement since the mid-2010s. Additional effort should be made to increase recognition of sudden headache with no known cause in US regions with current high prevalence of stroke risk factors.

Abstract WMP54: Estimates of the U.S. Burden of Pregnancy-Associated Stroke Attributable to Common Vascular Risk Factors

Background: The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain. Methods: We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time. Results: The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period. Conclusions: Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.

Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p&lt;0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p&lt;0.0001), coronary artery disease (p&lt;0.0001), smoking (p&lt;0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p&lt;0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p&lt;0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.