title: Specificities of Ischemic Stroke Risk Factors in Arab-Speaking Countries.
abstract: Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries.
  
  
  
  We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (n = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both p ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; p = 0.07). Key Messages: Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.
authors.affiliation: Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon.
authors.forename: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Leila
authors.initials: L
authors.lastname: Sissani
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Antonio
authors.initials: A
authors.lastname: Arauz
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
authors.forename: Alain
authors.initials: A
authors.lastname: Bryer
authors.forename: Angel
authors.initials: A
authors.lastname: Chamorro
authors.forename: Marc
authors.initials: M
authors.lastname: Fisher
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Kim M
authors.initials: KM
authors.lastname: Fox
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.forename: Ayrton
authors.initials: A
authors.lastname: Massaro
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Mario
authors.initials: M
authors.lastname: Munoz Collazos
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Bassem
authors.initials: B
authors.lastname: Yamouth
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D000349:Africa / Q000453:epidemiology; D000368:Aged; D018912:Arabs; D002545:Brain Ischemia / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D007802:Language; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015999:Multivariate Analysis; D011203:Poverty; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality