FACULTY OF PUBLIC HEALTH
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Item Echocardiographic abnormalities and determinants of 1-month outcome of stroke among West Africans in the SIREN Study(American Heart Association, 2019) Adeoye A. M.; Ovbiagele B.; Akinyemi J. O.; Ogah O. S.; Akinyemi R.; Gebregziabher M.; Wahab K.; Fakunle A. G.; Akintunde A.; Adebayo O.; Aje A.; Tiwari H. K; Arnett D.; Agyekum F.; Appiah L. T.; Amusa G.; Olunuga T. O.; Akpa O.; Sarfo F. S.; Akpalu A.; Jenkins C.; Lackland D.Background-—Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results-—We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2_14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions-—Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this associationItem Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study(World Stroke Organization Reprints and permissions, 2018) Akinyemi R. O.; Sarfo F. S.; Akinyemi J.; Singh A.; Akpa M. O.; Akpalu A.; Owolabi L.; Adeoye A. M.; Obiako R.; Wahab K.; Sanya E.; Komolafe M.; Ogbole G.; Fawale M.; Adebayo P.; Osaigbovo G.; Sunmonu T.; Olowoyo P.; Chukwuonye I.; Obiabo Y.; Adeniji O.; Fakunle G.; Melikam E.; Saulson R.; Yaria J.; Uwanruochi K.Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. Methods: A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants’ knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. Results: Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25–1.81) and a family history of stroke (OR 1.20, 1.03–1.39) while Islamic religion (OR¼0.82, CI: 0.72–0.94), being currently unmarried (OR ¼ 0.81, CI: 0.70–0.92), and alcohol use (OR ¼ 0.78, CI: 0.67–0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03– 1.74) but inversely associated with a medical history of high blood pressure (OR ¼ 0.79, 0.65–0.96). Conclusion: To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventionsItem Exploring overlaps between the genomic and environmental determinants of LVH and stroke(Elsevier Ltd, 2017) Adeoye A. M.; Ovbiagele B.; Kolo P.; Appiah L.; Ajek A.; Adebayo O.; Sarfo F.; Akinyemi J.; Adekunle G.; Agyekum F.; Shidali V.; Ogah O.; Lackland D.; Gebregziabher M.; Arnett D.; Tiwari H. K.; Akinyemi R.; Olagoke O. O.; Oguntade A. S.; Olunuga T.; Uwanruochi K.; Jenkins C.; Adadey P.; Iheonye H.; Owolabi L.; Obiako R.; Akinjopo S.; Armstrong K.; Akpalu A.; Fakunle A.; Saulson R.; Aridegbe M.; Olowoyo P.; Osaigbovo G.; Akpa O.Background: Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. Objectives: We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. Methods: SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. Results: This preliminary analysis included only 725 stroke patients (mean age 59.1 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 12.8 vs. 60.6 13.4; p ¼ 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). Conclusions: The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry