Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

I absolutely hate, hate, hate this focus. It is just an excuse to not solve any of the many fucking problems in stroke. BLAME THE VICTIM! You caused it yourself, you figure out how to recover yourself. And our fucking failures of stroke associations follow this idea.
You Goddamned lazy assholes.  Schadenfreude is going to be tough for you.
http://www.mdlinx.com/internal-medicine/medical-news-article/2016/07/21/stroke/6759391/?

The Lancet, 07/21/2016 O'Donnell MJ, et al.

Researchers explored different regions of the world, and key populations to quantify the importance of potentially modifiable risk factors and primary pathological subtypes of for stroke. The results revealed important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case–mix of stroke and preventing stroke by developing both global and region–specific programmes.

Methods

• Standardised international case–control study was performed in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa, in cases with acute first stroke patients(within 5 days of symptom onset and 72 h of hospital admission).
• Hospital–based or community–based individuals with no history of stroke were recruited in a 1:1 ratio, for age and sex, and were taken as controls and matched with cases.
• Clinical assessment of all patients was done and their blood and urine samples were collected.
• Odds ratios (OR) and their population attributable risks (PARs) with 99% confidence intervals, were calculated

Results

• 26919 participants were recruited from 32 countries (13447 cases [10388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13472 controls), between Jan 11, 2007, and Aug 8, 2015.
• Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist–to–hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke.
• These risk factors, collectively accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged <=55 years, 90·0% in patients aged >55 years).
• Regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which was observed for diet) and differences in prevalence of risk factors among regions were observed.
• The results suggested that association of hypertension was more with intracerebral haemorrhage as compared to ischaemic stroke whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).

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