Amarenco P., Abboud H., Labreuche J., Arauz A., Bryer A., Lavados P.M., Massaro A., Collazos M.M., Steg P.G., Yamout B.I., Vicaut E.
Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France; INSERM U-698 and Paris-Diderot University, Paris, France; Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon; National Institute of Neurology, Mexico City, Mexico; Division of Neurology and Stroke Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Neurology Service, Department of Medicine, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Department of Neurological Sciences, Universidad de Chile, Santiago, Chile; Neurologia, São Paulo, Brazil; Neurologia, Clinica de Marly, Bogota, Colombia; Department of Cardiology, Bichat University Hospital, Paris, France; Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biostatistics, Fernand Widal Hospital, Denis Diderot University - Paris VII, Paris, France
Amarenco, P., Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France, INSERM U-698 and Paris-Diderot University, Paris, France; Abboud, H., Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon; Labreuche, J., Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France, INSERM U-698 and Paris-Diderot University, Paris, France; Arauz, A., National Institute of Neurology, Mexico City, Mexico; Bryer, A., Division of Neurology and Stroke Unit, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Lavados, P.M., Neurology Service, Department of Medicine, Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile, Department of Neurological Sciences, Universidad de Chile, Santiago, Chile; Massaro, A., Neurologia, São Paulo, Brazil; Collazos, M.M., Neurologia, Clinica de Marly, Bogota, Colombia; Steg, P.G., INSERM U-698 and Paris-Diderot University, Paris, France, Department of Cardiology, Bichat University Hospital, Paris, France; Yamout, B.I., Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon; Vicaut, E., Department of Biostatistics, Fernand Widal Hospital, Denis Diderot University - Paris VII, Paris, France
Objective: We aimed to stratify the risk of vascular event recurrence in patients with cerebral infarction according to living and socioeconomic characteristics and geographic region. Method: The Outcomes in Patients with TIA and Cerebrovascular Disease (OPTIC) study is an international prospective study of patients aged 45 years or older who required secondary prevention of stroke [following either an acute transient ischemic attack, minor ischemic strokes, or recent (less than six-months previous), stable, first-ever, nondisabling ischemic stroke]. A total 3635 patients from 245 centers in 17 countries in four regions (Latin America, Middle East, North Africa, South Africa) were enrolled between 2007 and 2008. The outcome measure was the two-year rate of a composite of major vascular events (vascular death, myocardial infarction and stroke). Results: During the two-year follow-up period, 516 patients experienced at least one major cardiovascular event, resulting in an event rate of 15·6% (95% confidence interval 14·4-16·9%). Event rates varied across geographical region (P<0·001), ranging from 13·0% in Latin America to 20·7% in North Africa. Unemployment status, living in a rural area, not living in fully serviced accommodation (i.e., house or apartment with its own electricity, toilet and water supply), no health insurance coverage, and low educational level (less than two-years of schooling) were predictors of major vascular events. Major vascular event rates steeply increased with the number of low-quality living/socioeconomic conditions (from 13·4% to 47·9%, adjusted P value for trend <0·001). Conclusion: Vascular risk in stroke patients in low- and middle-income countries varies not only with the number of arterial beds involved but also with socioeconomic variables. © 2014 World Stroke Organization.