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Abstract - The modified risk factors of ischemic stroke
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Zarina Babaeva, Yerzhan Uteuliyev, Latina Tekebaeva, Kairat Karibaev

ABSTRACT

Strokes, being a heterogeneous syndrome, are the result of multifactorial accumulative disorders of the body. The urgency of the problem of cerebral stroke is due to the high level of occurrence and prevalence on a global scale, as well as the consequences. Thus, vascular diseases of the brain vessels occupy the second place in the structure of mortality from diseases of the circulatory system and total mortality of the population. The expected aging of the population, coupled with a decrease in mortality from stroke, creates a predisposition to an increase in the burden of strokes in the form of an increase in the number of victims.

In Kazakhstan, as in most countries of the world, ischemic strokes prevail, which are the main cause of disability of the working-age population. Despite certain advances in the treatment of brain catastrophes caused by the introduction of protocols for early diagnosis and the development of algorithms for urgent actions, as well as the development of innovative pharmaceutical approaches, prevention of stroke development remains the most effective approach in all respects - medical, economic, social.

Risk factors for stroke can be classified as changeable (modifiable) and not subject to change (non-modifiable, or risk markers). Age, gender and race, ethnicity, genetic predisposition are unchangeable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet and physical inactivity are among the most common modifiable risk factors.

Stroke prevention mainly focuses on managing variable risk factors. Lifestyles and behavior modification, such as changes in diet or smoking cessation, not only reduce stroke risk, but also reduce the risk of other cardiovascular diseases. Other preventive areas include the identification and treatment of diseases that increase the risk of stroke, such as hypertension, diabetes and atrial fibrillation.

Key words: cerebral stroke, ischemic stroke, risk factors, modifiable risk factors, arterial hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation

Corresponding Author: Zarina Babaeva, Kazakhstan Medical University “Higher School of Public Healthcare”. Address: 19a Utepov Street, Almaty, Republic of Kazakhstan. Tel.: +77781622003. E-mail: familymed@inbox.ru

 

REFERENCES

1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006; 367:1747-1757. https://doi.org/10.1016/S0140-6736(06)68770-9

2. Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circulation Research. 2017; 120:439-448. https://doi.org/10.1161/CIRCRESAHA.116.308413

3. Ovbiagele B, Goldstein LB, Higashida RT, Howard VJ, Johnston SC, Khavjou OA, et al. American Heart Association Advocacy Coordinating Committee and Stroke Council. Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke. 2013;44:2361–2375. https://doi.org/10.1161/STR.0b013e31829734f2

4. Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR, et al. American Heart Association Council on Epidemiology and Prevention. American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013; 127:1730–1753. https://doi.org/10.1161/CIR.0b013e31828f8a94

5. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update. A Report from the American Heart Association. Circulation. 2017; 135(10): e146–e603. https://doi.org/10.1161/CIR.0000000000000485

6. Truelsen T, Heuschmann PU, Bonira R, Arjundas G, Dalal P, Damasceno A. et al. Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). The Lancet, Neurology. 2007; 6(2):134-139. https://doi.org/10.1016/S1474-4422(06)70686-X

7. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014; 129(3):e28-e292. https://doi.org/10.1161/01.cir.0000441139.02102.80

8. Feigin VL, Forouzanfar MH, Krishnamurthi R. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 18 (383):245-254. https://doi.org/10.1016/S0140-6736(13)61953-4

9.Noncommunicable diseases country profiles, 2014 http://www.who.int/nmh/countries/kaz_en.pdf?ua=1

10. Statisticheskij sbornik "Zdorov'e naselenija Respubliki Kazahstan i dejatel'nosti organizacij zdravoohranenija v 2017 godu" (The statistical bulletin "Health in the Republic of Kazakhstan and healthcare in 2017) [in Russian].

11. Goldstein LB., Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42(2):517-84. https://doi.org/10.1161/STR.0b013e3181fcb238

12. Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the Primary Prevention of Stroke. A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45:3754–3832. https://doi.org/10.1161/STR.0000000000000046

13. Feigin VL, Krishnamurthi R, Bhattacharjee R. New strategy to reduce the global burden of stroke. Stroke. 2015; 46(9):1740–1747. https://doi.org/10.1161/STROKEAHA.115.008222

14. Sacco RL, Benjamin EJ, Broderick JP, Dyken M, Easton JD, Feinberg WM, et al. American Heart Association prevention conference. IV. Prevention and rehabilitation of stroke. Risk factors. Stroke. 1997; 28(7):1507-17. https://doi.org/10.1161/01.STR.28.7.1507

15. O'Donnell M, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE Study): a case-control study. Lancet. 2010; 376:112-123. https://doi.org/10.1016/S0140-6736(10)60834-3

16. Elkind MS. Why now? Moving from stroke risk factors to stroke triggers. Curr Opin Neurol. 2007; 20:51–57. https://doi.org/10.1097/WCO.0b013e328012da75

17. Di Legge S, Koch G, Diomedi M, Stanzione P, Sallustio F. Stroke prevention: managing modifiable risk factors. Stroke Res Treat. 2012; 2012:391538. https://doi.org/10.1155/2012/391538

18. Sierra C, Coca A. High blood pressure, alcohol, and cardiovascular risk. Eur. Society of Hypertension Scient. Newsletter. 2011; 12(39):177-189.

19. Turin TC, Okamura T, Afzal AR, Rumana N, Watanabe M, Higashiyama A, et al. Hypertension and lifetime risk of stroke. J Hypertens. 2016; 34(1):116-22. https://doi.org/10.1097/HJH.0000000000000753

20. Lewington S, Clarke R. Combined effects of systolic blood pressure and total cholesterol on cardiovascular disease risk. Circulation. 2005; 112:3373–3374. https://doi.org/10.1161/CIRCULATIONAHA.105.581934

21. Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al, Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT–LLA): a multicentre randomised controlled trial. Lancet. 2003; 361(9364):1149–1158. https://doi.org/10.1016/S0140-6736(03)12948-0

22. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003; 326(7404):1419. https://doi.org/10.1136/bmj.326.7404.1419

23. MacMahon S, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hypertens. 1993; 15(6):967–978. https://doi.org/10.3109/10641969309037085

24. Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A, et al. Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials. Hypertension. 2017; 69(1):171-179. https://doi.org/10.1161/HYPERTENSIONAHA.116.08485

25. Bejot Y, Giroud M. Stroke in diabetic patients. Diabetes Metab. 2010; 36:84-87. https://doi.org/10.1016/S1262-3636(10)70472-9

26. Tuttolomondo A, Pinto A, Salemi G, Di Raimondo D, Di Sciacca R, Fernandez P, et al. Diabetic and non-diabetic subjects with ischemic stroke: differences, subtype distribution and outcome. Nutr Metab Cardio vasc Dis. 2008; 18(2):152–157. https://doi.org/10.1016/j.numecd.2007.02.003

27. Strazzullo P, D'Elia L, Cairella G, Garbagnati F, Cappuccio FP, Scalfi L. Excess body weight and incidence of stroke. Meta-analysis of prospective studies with 2 million participants. Stroke. 2010; 4:15-25. https://doi.org/10.1161/STROKEAHA.109.576967

28. Putaala J, Liebkind R, Gordin D, Thorn LM, Haapaniemi E, Forsblom C, et al. Diabetes mellitus and ischemic stroke in the young: clinical features and long-term prognosis. Neurology. 2011; 76(21):1831-7. https://doi.org/10.1212/WNL.0b013e31821cccc2

29. Akpalu J, Yawson AE, Osei-Poku F, Atiase Y, Yorke E, Adjei P, et al. Stroke Outcome and Determinants among Patients with and without Diabetes in a Tertiary Hospital in Ghana. Stroke Res Treat. 2018; 7521351. https://doi.org/10.1155/2018/7521351

30. Kaarisalo MM, Räihä I, Sivenius J, Immonen-Räihä P, Lehtonen A, Sarti C, et al. Diabetes worsens the outcome of acute ischemic stroke. Diabetes Res Clin Pract. 2005; 69(3):293-8.
https://doi.org/10.1016/j.diabres.2005.02.001

31. Huxley R1, Lewington S, Clarke R. Cholesterol, coronary heart disease and stroke: a review of published evidence from observational studies and randomized controlled trials. Semin Vasc Med. 2002; 2(3):315-23. https://doi.org/10.1055/s-2002-35402

32. Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, White IR, et al. Lipoprotein (a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. Emerging Risk Factors Collaboration. JAMA. 2009; 302(4):412-23. https://doi.org/10.1001/jama.2009.1063

33. Aronis KN, Zhao D, Hoogeveen RC, Alonso A, Ballantyne CM, Guallar E, et al. Associations of Lipoprotein(a) Levels With Incident Atrial Fibrillation and Ischemic Stroke: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc. 2017; 6(12):e007372. https://doi.org/10.1161/JAHA.117.007372

34. Dzeshka MS, Shahid F, Shantsila A, Lip GYH. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens. 2017; 30(8):733-755. https://doi.org/10.1093/ajh/hpx013

35. Diener HC, Weber R, Lip GY, Hohnloser SH. Stroke prevention in atrial fibrillation: do we still need warfarin? Curr Opin Neurol. 2012; 25(1):27-35. https://doi.org/10.1097/WCO.0b013e32834e604a

36. Habibi-Koolaee M, Shahmoradi L, Niakan Kalhori SR, Ghannadan H, Younesi E. Prevalence of Stroke Risk Factors and Their Distribution Based on StrokeSubtypes in Gorgan: A Retrospective Hospital-Based Study-2015-2016. Neurol Res Int. 2018; 2018:2709654. https://doi.org/10.1155/2018/2709654

37. Fu-Liang Zhang, Zhen-Ni Guo, Yan-Hua Wu, Hao-Yuan Liu, Yun Luo, Ming-Shuo Sun, et al. Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China. BMJ Open. 2017; 7(9):e015758. https://doi.org/10.1136/bmjopen-2016-015758

 

Volume 4, Number 50 (2018)