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 IJCM  Vol.7 No.9 , September 2016
Risk Factors for Stroke in Sulaimaniyah Iraqi Kurdistan Region-Iraq
Abstract: Background: Stroke is a frequent medical problem and a leading cause of death and disability worldwide. Several conditions and life factors have been associated with stroke. Aim: To evaluate risk factors in stroke patients in Sulaimani city. Results: 110 patients with stroke were included in this study, hypertension was found to be the most common risk factor in current study. Out of 110 cases, 83 (75.5%) were hypertensive. Peak stroke-prone age was (60 - 69) year for male, (70 - 79) year for female. We found a statistically significant relation between level of TSC, LDL with ischemic stroke (r = 0.4047, P < 0.0001) and (r = 0.4052 P < 0.0001) respectively. While there was a significant inverse relation between HDL and ischemic stroke (Correlation coefficient = ?0.4862, P < 0.0001). On the other hand, there was no significant relation between level of TG and ischemic stroke (r = 0.2403, P < 0.0114). Also correlation statistic between TSC/HDL, LDL/HDL and result of CT scan, showed that there is statistical significance correlation between infarction and value of atherogenic index, (r = 0.5301, P < 0.0001, r = 0.4990, P < 0.0001) respectively, but there is no correlation between haemorhage & the index. Conclusion: Hypertension is the leading risk factor of stroke. It is therefore essential to detect and treat hypertension at its outset. High value of atherogenic index mostly associated with ischemic stroke .while no relation found with haemorhagic stroke.
Cite this paper: Mohamed, A. and Alshekhani, M. (2016) Risk Factors for Stroke in Sulaimaniyah Iraqi Kurdistan Region-Iraq. International Journal of Clinical Medicine, 7, 639-651. doi: 10.4236/ijcm.2016.79070.
References

[1]   Australian Institute of Health and Welfare (AIHW) (2005) Australian Hospital Statistics 2003-04. AIHW Cat. No. HSE 37. AIHW, Canberra.

[2]   Hankey, G.J. (2000) Transient Ischaemic Attacks and Stroke. Medical Journal of Australia, 172, 394-400.

[3]   National Stroke Foundation (2003) National Clinical Guidelines for Acute Stroke Management Melbourne: National Stroke Foundation.

[4]   Modan, B. and Wagener, D.K. (1992) Some Epidemiological Aspects of Stroke: Mortality/ Morbidity Trend, Age, Sex, Race, Socioeconomic Status. Stroke, 23, 1230-1236.
http://dx.doi.org/10.1161/01.STR.23.9.1230

[5]   AD - Department of Neurology, New England Medical Center, Boston, MA 02111, PMID-2671793.

[6]   Hart, C., Davey Smith, G. and Hole, D. (1999) Risk Factors and 20 Year Stroke Mortality in Men and Women in the Renfrew/Paisley Study in Scotland. Stroke, 30, 1999-2007.
http://dx.doi.org/10.1161/01.STR.30.10.1999

[7]   Sacco, R., Benjamin, E., Broderick, J., Dyken, M., Easton, J., Feinburg, W., Goldstein, L., Gorelick, P., Howard, G., Kittner, S., Manolio, T., Whisnant, J. and Wolf, P. (1997) American Heart Association Conference IV: Prevention and Rehabilitation of Stroke: Risk Factors. Stroke, 28, 1507-1517.
http://dx.doi.org/10.1161/01.STR.28.7.1507

[8]   (1993) Heart and Stroke Facts. American Heart Association, Dallas.

[9]   Wolf, P.A. (1998) Prevention of Stroke. Lancet, 352, 15-18.
http://dx.doi.org/10.1016/S0140-6736(98)90089-7

[10]   Park, J.E. and Park, K. (1995) Stroke: Textbook of Preventive and Social Medicine. 15th Edition, M/S Banarsidas Bhanot Publisher, Jabalpur, 245-246.

[11]   Ali, L., Jamil, H. and Shah, M.A. (1997) Risk Factors and Stroke. J CollPhysSurg Pak, 7, 7-10.

[12]   Stroke Unit Trialists’ Collaboration (2003) Organised Inpatient (Stroke Unit) Care for Stroke (Cochrane Review). The Cochrane Database of Systematic Reviews, Article ID: CD000197.

[13]   Malmgren, R., Warlow, C., Bamford, J. and Sandercock, P. (1990) Geographical and Secular Trends in Stroke Incidence. Lancet, 2, 1196-1200.

[14]   Sarkarati, D. and Reisdorff, E.J. (2002) Emergent CT Evaluation of Stroke. Emergency Medicine Clinics of North America, 20, 553-581.
http://dx.doi.org/10.1016/S0733-8627(02)00020-2

[15]   El-Koussy, M., Guzman, R., Bassetti, C., et al. (2000) CT and MRI in Acute Hemorrhagic Stroke. Cerebrovascular Diseases, 10, 480-482.
http://dx.doi.org/10.1159/000016113

[16]   Woisetschlager, C., Kittler, H., Oschatz, E., et al. (2000) Out-of-Hospital Diagnosis of Cerebral Infarction versus Intracranial Hemorrhage. Intensive Care Medicine, 26, 1561-1565.
http://dx.doi.org/10.1007/s001340000663

[17]   Phillips, S.J. and Whisnant, J.P. (1992) Hypertension and the Brain: The National High Blood Pressure Education Program. Archives of Internal Medicine, 152, 938-945.
http://dx.doi.org/10.1001/archinte.1992.00400170028006

[18]   The Expert Panel (1988) Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Archives of Internal Medicine, 148, 36-69.

[19]   National Stroke Association (1994) Cost of Stroke. Stroke Clinical Updates, 5, 9-12.

[20]   Wolf, P.A., D’Agostino, R.B., Kannel, W.B., Bonita, R. and Belanger, A.J. (1991) Age as a Risk Factor for Stroke: The Framingham Study. JAMA, 259, 1026-1029.

[21]   Ferris, A., Robertson, R.M., Fabunmi, R. and Mosca, L. (2005) American Heart Association and American Stroke Association National Survey of Stroke Risk Awareness among Women. Circulation, 111, 1321-1326.
http://dx.doi.org/10.1161/01.CIR.0000157745.46344.A1

[22]   Al-Rajeh, S., Awada, A., Niazi, G. and Larbi, E. (1993) Stroke in a Saudi Arabian National Guard Community. Analysis of 500 Consecutive Cases from a Population-Based Hospital. Stroke, 24, 1635-1639.
http://dx.doi.org/10.1161/01.STR.24.11.1635

[23]   Rodgers, A., MacMahon, S., Yee, T., Clark, T., Keung, C., Chen, Z., Bos, K. and Zhang, X. (1998) Blood Pressure, Cholesterol, and Stroke in Eastern Asia. The Lancet, 352, 1801-1807.
http://dx.doi.org/10.1016/S0140-6736(98)03454-0

[24]   Park, J.K., Kim, H.J., Koh, S.B. and Koh, S.Y. (1998) Risk Factors for Hemorrhagic Stroke in Wonju, Korea. Yonsei Medical Journal, 39, 229-235.
http://dx.doi.org/10.3349/ymj.1998.39.3.229

[25]   MacMahon, S., Peto, R., Cutler, J., Collins, R., Sorlie, P., Neaton, J., Abbott, R., Godwin, J., Dyer, A. and Stamler, J. (1990) Blood Pressure, Stroke, and Coronary Heart Disease, Part 1: Prolonged Differences in Blood Pressure: Prospective Observational Studies Corrected for the Regression Diluted Bias. The Lancet, 335, 765-774.
http://dx.doi.org/10.1016/0140-6736(90)90878-9

[26]   Kannel, W.B. (1996) Blood Pressure as a Cardiovascular Risk. JAMA, 275, 1571-1576.
http://dx.doi.org/10.1001/jama.1996.03530440051036

[27]   Bronner, L.L., Kanter, D.S. and Manson, J.E. (1995) Primary Prevention of Stroke. The New England Journal of Medicine, 333, 1392-1400.
http://dx.doi.org/10.1056/NEJM199511233332106

[28]   Fukiyama, K., Takishita, S., Muratani, H. and Kimura, Y. (1994) Trends in the Incidence of Cardiovascular Disease and the Treatment of Hypertension in Japan. Hypertension Research, 17, 215-219.

[29]   MRC Working Party (1992) Medical Research Council Trial of Treatment of Hypertension in Older Adults: Principal Results. BMJ, 304, 405-412.
http://dx.doi.org/10.1136/bmj.304.6824.405

[30]   Dunbabin, D.W. and Sandercock, P.A.G. (1990) Preventing Stroke by the Modification of Risk Factors. Stroke, 21, IV-36-39.

[31]   SHEP Cooperative Research Group (1992) Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons with Isolated Systolic Hypertension: Final Results of Systolic Hypertension in the Elderly Program (SHEP). JAMA, 265, 3255-3264.

[32]   Insua, J.T., Sacks, H.S., Lau, T., Lau, J., Reitman, D., Pagano, D. and Chalmers, T.C. (1994) Drug Treatment of Hypertension in the Elderly: A Meta-Analysis. Annals of Internal Medicine, 121, 355-362.
http://dx.doi.org/10.7326/0003-4819-121-5-199409010-00008

[33]   Staessen, J.A., Fagard, R., Thijs, L., Celis, H., Arabidze, G.G., Birkenhäger, W.H., Bulpitt, C.J., de Leeuw, P.W., Dollery, C.T., Fletcher, A.E., Forette, F., Leonetti, G., Nachev, C., O’Brien, E.T., Rosenfeld, J., Rodicio, J.L., Tuomilehto, J. and Zanchetti, A. (1997) Randomised Double-Blind Comparison of Placebo and Active Treatment for Older Patients with Isolated Systolic Hypertension. The Lancet, 350, 757-764.
http://dx.doi.org/10.1016/S0140-6736(97)05381-6

[34]   Amery, A., Birkenhager, W., Bulpitt, C., et al. (1991) Syst-Eur. A Multicentre Trial on the Treatment of Isolated Systolic Hypertension in the Elderly: Objectives, Protocol and Organization. Aging Clinical and Experimental Research, 3, 287-302.
http://dx.doi.org/10.1007/bf03324024

[35]   Department of Health and Human Services (1990) The Health Benefits of Smoking Cessation: A Report of the Surgeon General. DHHS Publication No. (CDC) 90-8416, Government Printing Office, Washington DC.

[36]   Kawachi, I., Colditz, G.A., Stampfer, M.J., et al. (1993) Smoking Cessation and Decreased Risk of Stroke in Women. JAMA, 269, 232-236.
http://dx.doi.org/10.1001/jama.1993.03500020066033

[37]   Shinton, R. and Beevers, G. (1989) Meta-Analysis of Relation between Cigarette Smoking and Stroke. BMJ, 298, 789-794.
http://dx.doi.org/10.1136/bmj.298.6676.789

[38]   Kubota, K., Yamaguchi, T., Abe, Y., Fugiwara, T., Hutazawa, J. and Matsuzawa, T. (1990) Effects of Smoking on Regional Cerebral Blood Flow in Neurologically Normal Subjects. Stroke, 14, 720-724.
http://dx.doi.org/10.1161/01.STR.14.5.720

[39]   Ruderman, N.B. and Haudenschild, C. (1984) Diabetes as an Atherogenic Factor. Progress in Cardiovascular Diseases, 26, 373-412.
http://dx.doi.org/10.1016/0033-0620(84)90011-2

[40]   Tanaka, H., Ueda, Y., Hayashi, M., et al. (1982) Risk Factors for Cerebral Hemorrhage and Cerebral Infarction in a Japanese Rural Community. Stroke, 13, 62-73.
http://dx.doi.org/10.1161/01.STR.13.1.62

[41]   Benfante, R., Yano, K., Hwang, L.J., Curb, J.D., Kagan, A. and Ross, W. (1994) Elevated Serum Cholesterol Is a Risk Factor for Both Coronary Heart Disease and Thromboembolic Stroke in Hawaiian Japanese Men. Implications of Shared risk. Stroke, 25, 814-820.
http://dx.doi.org/10.1161/01.STR.25.4.814

[42]   Atkins, D., Psaty, B.M., Koepsell, T.D., Longstreth Jr., W.T. and Larson, E.B. (1993) Cholesterol Reduction and the Risk for Stroke in Men: A Meta-Analysis of Randomized, Controlled Trials. Annals of Internal Medicine, 119, 136-145.
http://dx.doi.org/10.7326/0003-4819-119-2-199307150-00008

[43]   Jacobs, D., Blackburn, H., Higgins, M., et al. (1992) Report of the Conference on Low Blood Cholesterol: Mortality Associations. Circulation, 86, 1046-1060.
http://dx.doi.org/10.1161/01.CIR.86.3.1046

[44]   Tell, G.S., Crouse, J.R. and Furberg, C.D. (1988) Relation between Blood Lipids, Lipoproteins, and Cerebrovascular Atherosclerosis. A Review. Stroke, 19, 423-430.
http://dx.doi.org/10.1161/01.STR.19.4.423

[45]   Kiechl, S., Willeit, J., Rungger, G., Egger, G., Oberhollenzer, F. and Bonora, E., for the Bruneck Study Group (1998) Alcohol Consumption and Atherosclerosis: What Is the Relation? Prospective Results from the Bruneck Study. Stroke, 29, 900-907.
http://dx.doi.org/10.1161/01.STR.29.5.900

[46]   Hillbom, M., Juvela, S. and Numminen, H. (1999) Alcohol Intake and the Risk of Stroke. European Journal of Preventive Cardiology, 6, 223-228.
http://dx.doi.org/10.1177/204748739900600406

[47]   Hannaford, P.C., Croft, P.R. and Kay, C.R. (1994) Oral Contraception and Stroke: Evidence from the Royal College of General Practitioners’ Oral Contraception Study. Stroke, 25, 935-942.
http://dx.doi.org/10.1161/01.STR.25.5.935

[48]   Thorogood, M., Mann, J., Murphy, M. and Vessey, M. (1992) Fatal Stroke and Use of Oral Contraceptives: Findings from a Case-Control Study. American Journal of Epidemiology, 136, 35-45.

[49]   Stampfer, M.J., Willett, W.C., Colditz, G.A., Speizer, F.E. and Hennekens, C.H. (1988) A Prospective Study of Past Use of Oral Contraceptive Agents and Risk of Cardiovascular Diseases. The New England Journal of Medicine, 319, 1313-1317.
http://dx.doi.org/10.1056/NEJM198811173192004

[50]   Katerndahl, D.A., Realini, J.P. and Cohen, P.A. (1992) Oral Contraceptive Use and Cardiovascular Disease: Is the Relationship Real or Due to Study Bias? The Journal of Family Practice, 35, 147-157.

[51]   Sandercock, P., Bamford, J., Dennis, M., et al. (1992) Atrial Fibrillation and Stroke: Prevalence in Different Types of Stroke and Influence on Early and Long Term Prognosis (Oxfordshire Community Stroke Project). BMJ, 305, 1460-1465.
http://dx.doi.org/10.1136/bmj.305.6867.1460

[52]   (1994) Risk Factors for Stroke and Efficacy of Antithrombotic Therapy in Atrial Fibrillation: Analysis of Pooled Data from Five Randomized Controlled Trials. Archives of Internal Medicine, 154, 1449-1457.
http://dx.doi.org/10.1001/archinte.1994.00420130036007

[53]   Miller, V.T., Pearce, L.A., Feinberg, W.M., Rothrock, J.F., Anderson, D.C. and Hart, R.G. (1996) Differential Effect of Aspirin Versus Warfarin on Clinical Stroke Types in Patients with Atrial Fibrillation. Neurology, 46, 238-240.
http://dx.doi.org/10.1212/WNL.46.1.238

[54]   Wannamethee, G., Shaper, A., Whincup, P. and Walker, M. (1998) Adult Height, Stroke and Coronary Heart Disease. American Journal of Epidemiology, 148, 1069-1076.
http://dx.doi.org/10.1093/oxfordjournals.aje.a009584

[55]   Longstreth Jr., W.T., Bernick, C., Fitzpatrick, A., et al. (2001) Frequency and Predictors of Stroke Death in 5,888 Participants in the Cardiovascular Health Study. Neurology, 56, 368-375.
http://dx.doi.org/10.1212/WNL.56.3.368

[56]   Tefferi, A., Solberg, L.A. and Silverstein, M.N. (2000) A Clinical Update in Polycythemia Vera and Essential Thrombocythemia. The American Journal of Medicine, 109, 141-149.
http://dx.doi.org/10.1016/S0002-9343(00)00449-6

[57]   Wannamethee, G., Perry, I.J. and Shaper, A.G. (1994) Haematocrit, Hypertension and Risk of Stroke. Journal of Internal Medicine, 235, 163-168.
http://dx.doi.org/10.1111/j.1365-2796.1994.tb01050.x

[58]   Kannel, W.B., Gordon, T., Wolf, P.A. and McNamara, P. (1972) Hemoglobin and the Risk of Cerebral Infarction: The Framingham Study. Stroke, 3, 409-420.
http://dx.doi.org/10.1161/01.STR.3.4.409

[59]   Pearson, T.C. (1987) 2 Rheology of the Ab-solute Polycythaemias. Baillière’s Clinical Haematology, 1, 637-664.
http://dx.doi.org/10.1016/s0950-3536(87)80019-7

[60]   Perloff, J.K., Marelli, A.J. and Miner, P.D. (1993) Risk of Stroke in Adults with Cyanotic Congenital Heart Disease. Circulation, 87, 1954-1959.
http://dx.doi.org/10.1161/01.CIR.87.6.1954

[61]   Jha, S.K., Anand, A.C., Sharma, V., Kumar, N. and Adya, C.M. (2004) Stroke at High Altitude: Indian Experience. High Altitude Medicine & Biology, 3, 21-27.
http://dx.doi.org/10.1089/152702902753639513

[62]   Pearson, T.C., Humphrey, P.R.D., Thomas, D.J. and Wetherley-Mein, G. (1999) Hematocrit, Blood Viscosity, Cerebral Blood Flow, and Vascular Occlusion. In: Lowe, G.D., Barbenel, J.C. and Forbes, C.D., Eds., Clinical Aspects of Blood Viscosity and Cell Deformability, Springer-Verlag, Berlin, 97-107.

[63]   Merino, A., Hauptma, P., Badimon, L., et al. (1992) Echocardiographic “Smoke” Is Produced by an Interaction of Erythrocytes and Plasma Proteins Modulated by Shear Forces. Journal of the American College of Cardiology, 20, 1661-1668.
http://dx.doi.org/10.1016/0735-1097(92)90463-W

[64]   Black, I.W., Hopkins, A.P., Lee, L.C.L. and Walsh, W.F. (1991) Left Atrial Spontaneous Echo Contrast: A Clinical and Echocardiographic Analysis. Journal of the American College of Cardiology, 18, 398-404.
http://dx.doi.org/10.1016/0735-1097(91)90592-W

[65]   Krumholz, H.M., Larson, M. and Levy, D. (1995) Prognosis of Left Ventricular Geometric Patterns in the Framingham Heart Study. Journal of the American College of Cardiology, 25, 879-884.
http://dx.doi.org/10.1016/0735-1097(94)00473-4

[66]   Levy, D., Garrison, R.J., Savage, D.D., Kannel, W.B. and Castelli, W.P. (1990) Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study. The New England Journal of Medicine, 322, 1561-1566.
http://dx.doi.org/10.1056/NEJM199005313222203

[67]   Schillaci, G., Verdecchia, P., Porcellati, G., Cuccurullo, O., Cosco, C. and Perticone, F. (2000) Continuous Relation between Left Ventricular Mass and Cardiovascular Risk in Essential Hypertension. Hypertension, 35, 580-586.
http://dx.doi.org/10.1161/01.HYP.35.2.580

[68]   Boon, A., Lodder, J., Cheriex, E. and Kessels, F. (1996) Risk of Stroke in a Cohort of 815 Patients with Calcification of the Aortic Valve with or without Stenosis. Stroke, 27, 847-851. http://dx.doi.org/10.1161/01.STR.27.5.847

[69]   Galante, A., Pietroiusti, A., Vellini, M., Piccolo, P., Possati, G., Bonis, M.D., Grillo, R.L., Fontana, C. and Favalli, C. (2001) C-Reactive Protein Is Increased in Patients with Degenerative Aortic Valvular Stenosis. Journal of the American College of Cardiology, 38, 1078-1082. http://dx.doi.org/10.1016/S0735-1097(01)01484-X

[70]   Gardin, J.M., McClelland, R., Kitzman, D., Lima, J.A.C., Bommer, W., Klopfenstein, H.S., Wong, N.D., Smith, V.E. and Gottdiener, J. (2001) M-Mode Echocardiographic Predictors of Six- to Seven-Year Incidence of Coronary Heart Disease, Stroke, Congestive Heart Failure, and Mortality in an Elderly Cohort (The Cardiovascular Health Study). The American Journal of Cardiology, 87, 1051-1057.
http://dx.doi.org/10.1016/S0002-9149(01)01460-6

[71]   Meijboom, F., Hess, J., Szatmari, A., et al. (1993) Long Term Follow-Up (9 - 20 Years) after Surgical Closure of Atrial Septal Defect at Young Age. The American Journal of Cardiology, 72, 1431-1433.
http://dx.doi.org/10.1016/0002-9149(93)90192-F

[72]   Shah, D., Azhar, M., Oakley, C.M., Cleland, J.G.F. and Nihoyannopoulos, P. (1994) Natural History of Secundum Atrial Septal Defect in Adults after Medical or Surgical Treatment: A Historical Prospective Study. British Heart Journal, 71, 224-228.
http://dx.doi.org/10.1136/hrt.71.3.224

[73]   Knepper, L.E., Biller, J., Adams Jr., H.P. and Bruno, A. (1988) Neurologic Manifestations of Atrial Myxoma. A 12-Year Experience and Review. Stroke, 19, 1435-1440.
http://dx.doi.org/10.1161/01.STR.19.11.1435

[74]   Kessab, R., Wehbe, L., Badaoui, G., el Asmar, B., Jebara, V. and Ashoush, R. (1999) Recurrent Cerebrovascular Accident: Unusual and Isolated Manifestation of Myxoma of the Left Atrium. Le Journal Médical Libanais, 47, 246-250.

 
 
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