Introduction
: Stroke is the main cause of adult disability and the second most leading cause of death worldwide. The number of deaths due to stroke is 5·54 million worldwide. Stroke is also a major cause of long‐term disability. Globally, 70% of strokes and 87% of both stroke‐related deaths and disability‐adjusted life years occur in low and middle‐income countries. The incidence of stroke varies among various countries. Over the last four decades, the stroke incidence in low and middle‐income countries has become more than doubled. . However, there are limited data and very few studies on various subtypes of ischemic stroke and their risks factors in our country. So, we purposively designed this study. The aim of this study was to investigate the risks factors associated with the various subtypes of ischemic stroke according to TOAST criteria.
Methods
: This was a prospective observational cross sectional study conducted during June‐2019 to May‐2020. A total of 220 ischemic stroke patients aged above 30 years confirmed by CT Scan/MRI of brain were included in this study. A complete history was taken regarding hypertension, diabetes, dyslipidemia, ischemic heart disease, current smoking history of previous stroke, positive familial history, coronary artery diseases, alcohol consumption and demographic characteristics were noted in the questionnaire. Hypertension was defined as systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure > 90 mmHg or both on two separate occasions, or the use of anti‐hypertensive medication at any time before the onset of stroke. Diabetes was defined if fasting plasma glucose levels are 126 mg/dl or higher after an overnight fast on more than one occasion or as random blood glucose level 200 mg/dl or higher on more than one occasion. Ischemic stroke was classified according to TOAST criteria. Data were collected with a pre structured questionnaire from the patients’ investigations reports and face to face interview with the researcher (an expert neurologist).
Results
: Among the 220 stroke patients, Large‐artery atherosclerosis (LAA), Cardio‐embolism (CE), Small‐vessel occlusion (SVO, Stroke of other determined etiology (SODE) and Stroke of undetermined etiology (SUDE) were being observed 84(38.18%), 14(6.36%), 63(28.64%), 12(5.45%) and 47(18.18%). The highest prevalence of subtypes 70(31.82%) was found in the age group (51‐60). The prevalence of subtypes was found 150(68.18%) in male and 70(31.82%) in female. 86(39.09%) prevalence of subtypes was found who were from rural areas whereas 134(60.91%) was observed in urban areas. The significant risk factors associated with the prevalence of various subtypes of ischemic stroke were observed Hypertension, Diabetes Mellitus, Smoking history, Dyslipidemia, Heart disease, H/O Previous Stroke, Positive Familial History, Coronary Artery Disease and Alcohol Consumption (p <0.05).
Conclusions
: The higher prevalence of Large‐artery atherosclerosis (LAA) was found in this study. It suggests the influence of uncontrolled hypertension, diabetes mellitus, smoking habit and dyslipidemia. So, importance should be given on various subtypes of ischemic stroke and collective preventive measures and strategies are to be taken to control the associated risk factors especially hypertension, diabetes mellitus, smoking habit and dyslipidemia to decrease the stroke mortality rate.