Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Martin J O'Donnell; Siu Lim Chin; Sumathy Rangarajan; Denis Xavier; Lisheng Liu; Hongye Zhang; Purnima Rao-Melacini; Xiaohe Zhang; Prem Pais; Steven Agapay; Patricio Lopez-Jaramillo; Albertino Damasceno; Peter Langhorne; Matthew J McQueen; Annika Rosengren; Mahshid Dehghan; Graeme J Hankey; Antonio L Dans; Ahmed Elsayed; Alvaro Avezum; Charles Mondo; Hans-Christoph Diener; Danuta Ryglewicz; Anna Czlonkowska; Nana Pogosova; Christian Weimar; Romaina Iqbal; Rafael Diaz; Khalid Yusoff; Afzalhussein Yusufali; Aytekin Oguz; Xingyu Wang; Ernesto Penaherrera; Fernando Lanas; Okechukwu S Ogah; Adesola Ogunniyi; Helle K Iversen; German Malaga; Zvonko Rumboldt; Shahram Oveisgharan; Fawaz Al Hussain; Daliwonga Magazi; Yongchai Nilanont; John Ferguson; Guillaume Pare; Salim Yusuf; INTERSTROKE investigators

doi:10.1016/S0140-6736(16)30506-2

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Martin J O'Donnell, Siu Lim Chin, Sumathy Rangarajan, Denis Xavier, Lisheng Liu, Hongye Zhang, Purnima Rao-Melacini, Xiaohe Zhang, Prem Pais, Steven Agapay, Patricio Lopez-Jaramillo, Albertino Damasceno, Peter Langhorne, Matthew J McQueen, Annika Rosengren, Mahshid Dehghan, Graeme J Hankey, Antonio L Dans, Ahmed Elsayed, Alvaro AvezumCharles Mondo, Hans-Christoph Diener, Danuta Ryglewicz, Anna Czlonkowska, Nana Pogosova, Christian Weimar, Romaina Iqbal, Rafael Diaz, Khalid Yusoff, Afzalhussein Yusufali, Aytekin Oguz, Xingyu Wang, Ernesto Penaherrera, Fernando Lanas, Okechukwu S Ogah, Adesola Ogunniyi, Helle K Iversen, German Malaga, Zvonko Rumboldt, Shahram Oveisgharan, Fawaz Al Hussain, Daliwonga Magazi, Yongchai Nilanont, John Ferguson, Guillaume Pare, Salim Yusuf, INTERSTROKE investigators

Institut for Klinisk Medicin

644 Citationer (Scopus)

Abstract

Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). Interpretation Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.

Originalsprog	Engelsk
Tidsskrift	The Lancet
Vol/bind	388
Udgave nummer	10046
Sider (fra-til)	761-75
Antal sider	15
ISSN	0140-6736
DOI	https://doi.org/10.1016/S0140-6736(16)30506-2
Status	Udgivet - 20 aug. 2016

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10.1016/S0140-6736(16)30506-2

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O'Donnell, M. J., Chin, S. L., Rangarajan, S., Xavier, D., Liu, L., Zhang, H., Rao-Melacini, P., Zhang, X., Pais, P., Agapay, S., Lopez-Jaramillo, P., Damasceno, A., Langhorne, P., McQueen, M. J., Rosengren, A., Dehghan, M., Hankey, G. J., Dans, A. L., Elsayed, A., ... INTERSTROKE investigators (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The Lancet, 388(10046), 761-75. https://doi.org/10.1016/S0140-6736(16)30506-2

O'Donnell, MJ, Chin, SL, Rangarajan, S, Xavier, D, Liu, L, Zhang, H, Rao-Melacini, P, Zhang, X, Pais, P, Agapay, S, Lopez-Jaramillo, P, Damasceno, A, Langhorne, P, McQueen, MJ, Rosengren, A, Dehghan, M, Hankey, GJ, Dans, AL, Elsayed, A, Avezum, A, Mondo, C, Diener, H-C, Ryglewicz, D, Czlonkowska, A, Pogosova, N, Weimar, C, Iqbal, R, Diaz, R, Yusoff, K, Yusufali, A, Oguz, A, Wang, X, Penaherrera, E, Lanas, F, Ogah, OS, Ogunniyi, A, Iversen, HK, Malaga, G, Rumboldt, Z, Oveisgharan, S, Al Hussain, F, Magazi, D, Nilanont, Y, Ferguson, J, Pare, G, Yusuf, S & INTERSTROKE investigators 2016, 'Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study', The Lancet, bind 388, nr. 10046, s. 761-75. https://doi.org/10.1016/S0140-6736(16)30506-2

@article{aac345ccd79044fea3f26b0a597aa406,

title = "Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study",

abstract = "Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). Interpretation Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region V{\"a}stra G{\"o}taland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.",

keywords = "Adult, Africa, Aged, Alcohol Drinking, Apolipoprotein A-I, Apolipoproteins B, Asia, Atrial Fibrillation, Australia, Biomarkers, Brain Ischemia, Case-Control Studies, Cerebral Hemorrhage, China, Diabetes Complications, Europe, Evidence-Based Medicine, Feeding Behavior, Female, Health Behavior, Humans, Hypertension, International Cooperation, Male, Middle Aged, Middle East, Motor Activity, Obesity, Abdominal, Odds Ratio, Risk Factors, Risk Reduction Behavior, Self Report, Smoking, Stroke, Waist-Hip Ratio, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't",

author = "O'Donnell, {Martin J} and Chin, {Siu Lim} and Sumathy Rangarajan and Denis Xavier and Lisheng Liu and Hongye Zhang and Purnima Rao-Melacini and Xiaohe Zhang and Prem Pais and Steven Agapay and Patricio Lopez-Jaramillo and Albertino Damasceno and Peter Langhorne and McQueen, {Matthew J} and Annika Rosengren and Mahshid Dehghan and Hankey, {Graeme J} and Dans, {Antonio L} and Ahmed Elsayed and Alvaro Avezum and Charles Mondo and Hans-Christoph Diener and Danuta Ryglewicz and Anna Czlonkowska and Nana Pogosova and Christian Weimar and Romaina Iqbal and Rafael Diaz and Khalid Yusoff and Afzalhussein Yusufali and Aytekin Oguz and Xingyu Wang and Ernesto Penaherrera and Fernando Lanas and Ogah, {Okechukwu S} and Adesola Ogunniyi and Iversen, {Helle K} and German Malaga and Zvonko Rumboldt and Shahram Oveisgharan and {Al Hussain}, Fawaz and Daliwonga Magazi and Yongchai Nilanont and John Ferguson and Guillaume Pare and Salim Yusuf and {INTERSTROKE investigators}",

year = "2016",

month = aug,

day = "20",

doi = "10.1016/S0140-6736(16)30506-2",

language = "English",

volume = "388",

pages = "761--75",

journal = "The Lancet",

issn = "0140-6736",

publisher = "TheLancet Publishing Group",

number = "10046",

}

TY - JOUR

T1 - Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE)

T2 - a case-control study

AU - O'Donnell, Martin J

AU - Chin, Siu Lim

AU - Rangarajan, Sumathy

AU - Xavier, Denis

AU - Liu, Lisheng

AU - Zhang, Hongye

AU - Rao-Melacini, Purnima

AU - Zhang, Xiaohe

AU - Pais, Prem

AU - Agapay, Steven

AU - Lopez-Jaramillo, Patricio

AU - Damasceno, Albertino

AU - Langhorne, Peter

AU - McQueen, Matthew J

AU - Rosengren, Annika

AU - Dehghan, Mahshid

AU - Hankey, Graeme J

AU - Dans, Antonio L

AU - Elsayed, Ahmed

AU - Avezum, Alvaro

AU - Mondo, Charles

AU - Diener, Hans-Christoph

AU - Ryglewicz, Danuta

AU - Czlonkowska, Anna

AU - Pogosova, Nana

AU - Weimar, Christian

AU - Iqbal, Romaina

AU - Diaz, Rafael

AU - Yusoff, Khalid

AU - Yusufali, Afzalhussein

AU - Oguz, Aytekin

AU - Wang, Xingyu

AU - Penaherrera, Ernesto

AU - Lanas, Fernando

AU - Ogah, Okechukwu S

AU - Ogunniyi, Adesola

AU - Iversen, Helle K

AU - Malaga, German

AU - Rumboldt, Zvonko

AU - Oveisgharan, Shahram

AU - Al Hussain, Fawaz

AU - Magazi, Daliwonga

AU - Nilanont, Yongchai

AU - Ferguson, John

AU - Pare, Guillaume

AU - Yusuf, Salim

AU - INTERSTROKE investigators

PY - 2016/8/20

Y1 - 2016/8/20

N2 - Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). Interpretation Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.

AB - Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). Interpretation Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.

KW - Adult

KW - Africa

KW - Aged

KW - Alcohol Drinking

KW - Apolipoprotein A-I

KW - Apolipoproteins B

KW - Asia

KW - Atrial Fibrillation

KW - Australia

KW - Biomarkers

KW - Brain Ischemia

KW - Case-Control Studies

KW - Cerebral Hemorrhage

KW - China

KW - Diabetes Complications

KW - Europe

KW - Evidence-Based Medicine

KW - Feeding Behavior

KW - Female

KW - Health Behavior

KW - Humans

KW - Hypertension

KW - International Cooperation

KW - Male

KW - Middle Aged

KW - Middle East

KW - Motor Activity

KW - Obesity, Abdominal

KW - Odds Ratio

KW - Risk Factors

KW - Risk Reduction Behavior

KW - Self Report

KW - Smoking

KW - Stroke

KW - Waist-Hip Ratio

KW - Journal Article

KW - Multicenter Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/S0140-6736(16)30506-2

DO - 10.1016/S0140-6736(16)30506-2

M3 - Journal article

C2 - 27431356

SN - 0140-6736

VL - 388

SP - 761

EP - 775

JO - The Lancet

JF - The Lancet

IS - 10046

ER -

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

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