Frequency & factors associated with recurrent stroke in Ghana and Nigeria

Background: Data on the burden and outcomes of recurrent strokes in sub-Saharan Africa are limited, impeding efforts at optimal recurrent stroke prevention. Objective: To assess the prevalence, risk factor profile, stroke types and mortality from recurrent strokes in Ghana and Nigeria. Methods: We analyzed data from 3553 stroke cases involved in the Stroke Investigative Research and Educational Networks (SIREN) study for proportion with recurrent strokes. Conditional logistic regression models were constructed to interrogate for risk factors of recurrent stroke compared with stroke-free controls. Generalized Linear models were used to assess correlates of recurrent strokes relative to index strokes. Results: Among stroke cases, 335 (9.4%) were recurrent strokes, of which 79.9% were ischemic and 20.1% hemorrhagic. Those with recurrent stroke were significantly older than index stroke cases 62.2 ± 12.9 years vs 58.9 ± 14.0 years, p < 0.01 respectively. Topmost risk factors associated with recurrent stroke were hypertension adjusted odds ratio 50.7 (95%CI: 6.6–392.7), dyslipidemia 2.8 (1.3–6.2), diabetes mellitus 4.0 (2.1–7.7) and family history of cardiovascular disease (CVD) 2.1 (1.1–4.2). The relative risk (95%CI) of factors associated with recurrent stroke vs index stroke were age > 50 years (1.5: 1.1–2.0); Hausa ethnicity (1.5:1.1–2.1), Yoruba ethnicity with Akan as referent; table added salt (0.4:0.2–0.8) and current alcohol intake (0.6:0.4–0.9). In-patient mortality among those with recurrent stroke vs. primary stroke was 20.5% vs. 21.4%. Conclusion: Several modifiable lifestyle related factors may warrant additional emphasis as targets for reducing the burden of recurrent stroke in sub-Saharan Africa.