22カ国で発血性脳卒中および脳内出血性脳卒中のリスク要因 (INTERSTROKE研究):症例対照研究

Martin J O'Donnell¹, Denis Xavier, Lisheng Liu

¹Population Health Research Institute, McMaster University, Hamilton, ON, Canada. odonnm@mcmaster.ca

Lancet (London, England)

|June 22, 2010

まとめ

高血圧や喫煙を含む10の主要なリスク要因が,世界的に脳卒中リスクの90%を占めています. 血圧,喫煙,ダイエット,運動を標的とした介入は,世界的な脳卒中の負担を大幅に軽減することができます.

科学分野:

グローバル・ヘルスグローバル・ヘルス
エピデミオロジーエピデミオロジー
心血管疾患心血管疾患

背景:

世界的な脳卒中の負担と様々なリスク要因の貢献は,特に低所得および中所得国では,まだ完全に理解されていません.
この研究は,既知および新興の危険因子と脳卒中サブタイプとの関連を特定し,脳卒中負担へのそれらの貢献を定量化し,脳卒中と心筋梗塞の危険因子を比較することを目的とした.

研究の目的:

既知および新興リスク因子の脳卒中およびその主要なサブタイプとの関連を確立する.
これらのリスク要因が,全世界の脳卒中の負担に与える影響を評価する.
脳卒中と心筋梗塞の危険因子の違いを調査する.

主な方法:

標準化された多国籍症例対照研究が22カ国で実施されました.
3000人の急性第一脳卒中患者と3000人の対照群を対象に,アンケート,身体検査,生物学的サンプルを介してデータを収集した.
確率比 (ORs) と集団関連リスク (PARs) は,脳卒中とそのサブタイプについて,さまざまなリスク要因に関連して計算されました.

主要な成果:

高血圧,現在の喫煙,高腰比,栄養不良,身体不活性,糖尿病,アルコール摂取,心理社会的ストレス,うつ病,心臓病の原因を含む10の危険因子は,すべてのタイプの脳卒中と有意に関連していました.
これらの10の要因は,全脳卒中に対する集団によるリスクの88.1%を占め,高血圧の拡張された定義を使用すると90.3%に上昇しました.
高血圧,喫煙,腰と腰の比率,食事,アルコールの摂取は,脳内出血性脳卒中の重要な危険因子でした.

結論:

脳卒中のリスクの有意な割合は,修正可能な10のリスク要因の定義されたセットに起因する.
血圧と喫煙率を低減し,身体活動と健康的な食事を促進することに焦点を当てた公衆衛生の介入は,世界的な脳卒中の負担を軽減する大きな可能性を秘めています.

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