Universidad del Desarrollo

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Demographics, Socio-Economic Characteristics, and Risk Factor Prevalence in Patients with Non-Cardioembolic Ischaemic Stroke in Low- and Middle-Income Countries: The OPTIC Registry
(2012)
Halim Abboud
;
Julien Labreuche
;
Antonio Arauz
;
Alan Bryer
;
Pablo G Lavados
<jats:sec><jats:title>Background</jats:title><jats:p> There is a paucity of data on patients with stroke/transient ischaemic attack in low- and middle-income countries. We sought to describe the characteristics and management of patients with an ischaemic stroke and recent transient ischaemic attack or minor ischaemic strokes in low- or middle-income countries. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The Outcomes in Patients with TIA and Cerebrovascular disease registry is an international, prospective study. Patients ≥45 years who required secondary prevention of stroke (either following an acute transient ischaemic attack or minor ischaemic strokes (National Institutes of Health Stroke Scale <4) of <24 h duration, or recent (<6 months), stable, first-ever, non-disabling ischaemic stroke) were enrolled in 17 countries in Latin America, the Middle East, and Africa. The main measures of interest were risk factors, comorbidities, and socio-economic variables. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Between January 2007 and December 2008, 3635 patients were enrolled in Latin America ( n =1543), the Middle East ( n =1041), North Africa ( n = 834), and South Africa ( n = 217). Of these, 63% had a stable, first-ever ischaemic stroke (median delay from symptom onset to inclusion, 25 days interquartile range, 7–77); 37% had an acute transient ischaemic attack or minor ischaemic stroke (median delay, two-days; interquartile range, 0–6). Prevalence of diabetes was 46% in the Middle East, 29% in Latin America, 35% in South Africa, and 38% in North Africa; 72% had abdominal obesity (range, 65–78%; adjusted P < 0·001); prevalence of metabolic syndrome was 78% (range, 72–84%, P < 0·001). Abnormal ankle brachial index (<0·9) was present in 22%, peripheral artery disease in 7·6%, and coronary artery disease in 13%. Overall, 24% of patients had no health insurance and 27% had a low educational level. </jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p> In this study, patients in low- and middle-income countries had a high burden of modifiable risk factors. High rates of low educational level and lack of health insurance in certain regions are potential obstacles to risk factor control. </jats:p></jats:sec><jats:sec><jats:title>Funding</jats:title><jats:p> The Outcomes in Patients with TIA and Cerebrovascular disease registry is supported by Sanofi-Aventis, Paris, France. </jats:p></jats:sec>
5Scopus© Citations 24
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Impact of Low Ankle-Brachial Index on the Risk of Recurrent Vascular Events Insights From the OPTIC Registry
(2019)
Halim Abboud
;
Linsay Monteiro Tavares
;
Julien Labreuche
;
Antonio Arauz
;
Alan Bryer
<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> Among 3487 enrolled patients, abnormal ABI (<0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely ( <jats:italic>P</jats:italic> <0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI <0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6–25.8 versus 13.7%; 21.4–15.1; <jats:italic>P</jats:italic> <0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6–0.9; 0.9–1; 1–1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0–48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8–25.0 for ABI 0.6–0.9 versus 14.3%; 95% CI, 12.4–16.6 for ABI 0.9–1 versus 13.3%; 95% CI, 11.6–15.2 for ABI 1–1.4; <jats:italic>P</jats:italic> <0.001). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.</jats:p> </jats:sec>
2Scopus© Citations 19

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