Key result
Prior smoking is linked to ~2.6-fold higher incident stroke risk in hypertensive or diabetic patients.
Why the study?
What are the incidence rates and risk factors associated with stroke occurrence in Ghanaian adults with hypertension and/or type II diabetes?
Cohort (n=3,220)
Yes
What are the incidence rates and risk factors associated with stroke occurrence in Ghanaian adults with hypertension and/or type II diabetes?
In a Ghanaian cohort with hypertension and/or diabetes, the incidence of stroke is high, with previous smoking, physical inactivity, and stage II hypertension identified as key modifiable risk factors.
Answers are grounded in this paper and cite their sources.
Smoking and inactivity were associated with higher stroke risk in this Ghanaian cohort; extends sparse African data but leaves open whether interventions reduce incidence.
BACKGROUND: The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. METHODS: A prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. RESULTS: Of 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77-18.38], with rates among diabetics with hypertension being 16.64 [10.58-25.00], hypertension of 13.77 [9.33-19.64] and diabetes was 9.81 [3.59-21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18-5.67) and physical inactivity, 1.81 (1.06-3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00-9.27), p = .05 for stroke occurrence. CONCLUSION: Incident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.
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Sarfo et al. (2018) conducted a cohort in Hypertension and/or Type 2 Diabetes Mellitus (n=3,220). Previous cigarette smoking vs. Never or former smoker was evaluated on Time to onset of new stroke (adjusted HR 2.59, 95% CI 1.18-5.67, p=0.02). Previous cigarette smoking and physical inactivity independently increased the risk of incident stroke among Ghanaians with hypertension and/or diabetes, with adjusted hazard ratios of 2.59 and 1.81, respectively.
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