Demographics, socio-economic characteristics, and risk factor prevalence in patients with non-cardioembolic ischaemic stroke in low- and middle-income countries: the OPTIC registry

BACKGROUND

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.

METHODS

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.

RESULTS

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.

INTERPRETATION

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.

FUNDING

The Outcomes in Patients with TIA and Cerebrovascular disease registry is supported by Sanofi-Aventis, Paris, France.

Abstract 2365: Impact of Socioeconomic Level on Cardiovascular Risk in Ischemic Stroke Patients: The OPTIC Registry

Background : The impact of socioeconomic factors (SEF) on the risk of future vascular events in stroke patients has been understudied. The Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry included patients in secondary prevention of stroke.

Objective : to stratify the risk of vascular event recurrence in patients with cerebral infarction according to presence of PAD, ankle-brachial index (ABI), known coronary artery disease (CAD), involvement of several arterial beds, geographic variations and SEF.

Method : Between January 2007 and December 2008, 3635 patients aged 45 years or older were enrolled in the OPTIC registry from 245 sites in 17 countries in the following regions: Latin America (1543 patients), Middle East (1041 patients), North Africa (834 patients), and South Africa (217 patients). PAD was present in 7.8%, ABI in 22%, CAD in 12.8%, and 31.1% were unemployed, 26.2% had less than 2 school years, 23% of patients had no health insurance, 12.8% lived in rural area, 8.4% lived alone, 7.5% did not live in a house/flat. Primary endpoint included vascular death (VD), myocardial infarction (MI) and stroke.

Results : During median follow-up of 731 days, 524 patients had at least 1 primary event; 190 patients had VD, 88 nonfatal MI, and 296 nonfatal stroke. The estimated risk of primary endpoint was 15.6% (95%CI, 14.4-17.0%) at 2-year. The risk increased with the number of vascular beds involved from 13.1% to 30.7% (p for trend<0.001). Using patients from Latin America as reference, age-sex-adjusted HR was 1.29 (95%CI, 1.04-1.60) for Middle East, 1.31 (95%CI, 0.90-1.89) for South Africa, and 1.64 (95%CI, 1.32-2.04) for North Africa. The absolute additional risk of having a primary endpoint ranged between, 4.7% for unemployed patients to 17.5% for patients not living in a house/flat. In multivariate analysis, living in rural area, not living in a house/flat, unemployment status, no health insurance cover, and less than 2-years school were associated with an increased cardiovascular risk (all adjusted p<0.004). There was a stepwise increase in the primary endpoint with the number of low SEF ranging from 13% to 62% (adjusted p-value for trend<0.001).

Conclusions : vascular risk in stroke patients in North and South Africa, Middle East and Latin America varies not only with the number of arterial beds involved but also with socio-economic variables, particularly poor health insurance cover, not living in a house/flat and low education level