Established and Emerging Risk Factors of Stroke in Asian Countries: A Systematic Review

Authors

  • Phornanan Jarintanan Keerapat International School, Bangkok, Thailand. Email: lassspasss@gmail.com
  • Nidhi Singh Keerapat International School, Bangkok, Thailand. Email: nidhi.sin@kpis.ac.th
  • Orasa Suthienkul Faculty of Public Health, Mahidol University, Bangkok, Thailand. Email: orasa.sut@mahidol.ac.th
  • Pichit Boonkrong College of Biomedical Engineering, Rangsit University, Pathum Thani. Thailand. Email: pichit.bk@gmail.com https://orcid.org/0000-0001-5105-0460

Keywords:

Aging society, Asia, Public health, Risk factor, Stroke

Abstract

This paper aims to review the stroke situation regarding its risk factors in 16 Asian countries. From the stroke incidence in 2016 and 2019, it was found that the number of stroke cases per 100,000 people increased in 10 and decreased in 6 Asian countries. Low-middle income countries (LMICs) tend to have lower service and quality of healthcare compared to high-income countries (HICs), this significant difference in healthcare might be what causes the difference in stroke incidence. A systematic review was conducted for identifying and rating the frequency of stroke risk factors. Reviewing 15 selected papers, there are eight risk factors for stroke ranging from hypertension15, diabetes12, hypercholesterolemia/dyslipidemia12, smoking11, physical inactivity7, obesity7, air quality2 to family history1. Age remains a significant risk factor for stroke, underscoring the importance of targeted preventive measures and healthcare interventions for older populations. China, as an example, has spread awareness and shown commitment to health issues and factors, adding institutions, and establishing a healthcare service for locations with more than 300,000. Studies have shown that women in LMICs are more likely to have a stroke at a young age compared to those in HICs, and could be influenced by cultural and social factors on women’s health. Therefore, individuals could decrease stroke risk through healthy lifestyle choices, preventing hypertension, diabetes, and hypercholesterolemia/dyslipidemia. Lifestyle modifications including not smoking, maintaining a healthy diet, and exercising regularly should lower the risk of stroke occurrence in individuals. Simultaneously, national policies could lower stroke incidences by strengthening the stroke care ecosystem.

References

Centers for Disease Control and Prevention, Spain. About Stroke. Available from: www.cdc.gov/stroke/about.htm#Ischemic, accessed 15 June, 2023.

GBD 2016 Stroke Collaborate. Global, regional, and national burden of stroke, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18(5): 439-58.

GBD 2019 Stroke Collaborate. Global, regional, and national burden of stroke and its risk factors, 19902019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20(5): 391-02.

Turana Y, Tengkawan J, Chia YC, Nathaniel M, Wang JG, Sukonthasarn A, et al; HOPE Asia Network. Hypertension and stroke in Asia: A comprehensive review from HOPE Asia. J Clin Hypertens (Greenwich) 2021; 23(3) : 513-21. DOI: 10.1111/jch.14099

Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review. J Stroke 2017; 19(3): 286-94. DOI: 10.5853/jos.2017.00234

Kim YD, Jung YH, Saposnik G. Traditional Risk Factors for Stroke in East Asia. J Stroke 2016; 18(3): 273-85. DOI: 10.5853/jos.2016.00885

Venketasubramanian N. The epidemiology of Stroke in ASEAN countries – A review. Neurol J Southeast Asia 1998; 3(2); 105-18.

Hata J, Kiyohara Y. Epidemiology of stroke and coronary artery disease in Asia. Circ J 2013; 77(8): 1923-32. DOI: 10.1253/circj.cj-13-0786

Xia X, Yue W, Chao B, Li M, Cao L, Wang L, et al. Prevalence and risk factors of stroke in the elderly in Northern China: National Stroke Screening Survey. J Neurol 2019; 266(6): 1449-58. DOI: 10.1007/s00415019-09281-5

Sharma VK, Tsivgoulis G, Teoh HL, Ong BK, Chan BP. Stroke risk factors and outcomes among various Asian ethnic groups in Singapore. J Stroke Cerebrovasc Dis 2012; 21(4): 299-04. DOI: 10.1016/j.jstrokecerebrovasdis.2010.08.010

Rajeev Ojha, Dongya Huang, Hedi An, Lian Zuo, Wenxia Zhu. Young ischemic stroke in South Asia: A review. Journal of Stroke and Cerebrovascular Diseases 2014; 23(7): 1753-159.

Chin YY, Sakinah H, Aryati A, Hassan BM. Prevalence, risk factors and secondary prevention of stroke recurrence in eight countries from south, east and southeast asia: a scoping review. Med J Malaysia 2018; 73(2): 90-99.

Lin X, Wang H, Rong X, Huang R, Peng Y. Exploring stroke risk and prevention in China: insights from an outlier. Aging (Albany NY) 2021; 13(11): 15659-73. DOI: 10.18632/aging.203096

Qi W, Ma J, Guan T, Zhao D, Abu-Hanna A, Schut M, et al. Risk Factors for Incident Stroke and Its Subtypes in China: A Prospective Study. J Am Heart Assoc 2020; 9(21): 1-19. DOI: 10.1161/JAHA.120.016352

Venketasubramanian N, Tan LC, Sahadevan S, Chin JJ, Krishnamoorthy ES, Hong CY, Saw SM. Prevalence of stroke among Chinese, Malay, and Indian Singaporeans: a community-based tri-racial cross-sectional survey. Stroke 2005; 36(3): 551-6. DOI: 10.1161/01.STR.0000155687.18818.13

Shahbandi A, Shobeiri P, Azadnajafabad S, Saeedi Moghaddam S, Sharifnejad Tehrani Y, Ebrahimi N, et al. Burden of stroke in North Africa and Middle East, 1990 to 2019: a systematic analysis for the global burden of disease study 2019. BMC Neurol 2022; 22(1): 1-11. DOI: 10.1186/s12883-022-02793-0

El-Hajj M, Salameh P, Rachidi S, Hosseini H. The epidemiology of stroke in the Middle East. Eur Stroke J 2016;1(3):180-98. DOI: 10.1177/2396987316654338

Johansson BB. Hypertension mechanisms causing stroke. Clin Exp Pharmacol Physiol 1999; 26(7): 563-5. DOI: 10.1046/j.1440-1681.1999.03081.x

American Heart Association, USA. How High Blood Pressure Can Lead to Stroke. Available from: www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-highblood-pressure-can-lead-to-stroke, accessed 25 June, 2023.

Stroke Association, England and Wales. High Blood Pressure. Available from: www.stroke.org.uk/whatis-stroke/are-you-at-risk-of-stroke/high-blood-pressure, accessed 25 June, 2023.

Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci 2016; 351(4): 380-6. DOI: 10.1016/j.amjms.2016.01.011

Stroke Association, England and Wales. Diabetes. Available from: www.stroke.org.uk/what-is-stroke/areyou-at-risk-of-stroke/diabetes, accessed 26 June, 2023.

Khan RSU, Nawaz M, Khan S, Raza HA, Nazir T, Anwar MS, et al. Prevalence of Dyslipidemia in Ischemic Stroke Patients: A Single-Center Prospective Study From Pakistan. Cureus 2022;14(6):1-6. DOI: 10.7759/cureus.25880

Stroke Association, England and Wales. High Cholesterol. Available from: www.stroke.org.uk/what-isstroke/are-you-at-risk-of-stroke/high-cholesterol#:~:text=on%20your%20health.,Why%20does%20high%20cholesterol%20increase%20your%20risk%20of%20stroke%3F,of%20a%20bl ood%20clot%20developing, accessed 29 June, 2023.

Otsuka T, Takada H, Nishiyama Y, Kodani E, Saiki Y, Kato K, et al. Dyslipidemia and the Risk of Developing Hypertension in a Working-Age Male Population. J Am Heart Assoc 2016; 5(3): 1-9. DOI: 10.1161/JAHA.115.003053

Perrault LP, Mahlberg F, Breugnot C, Bidouard J-P, Villeneuve N, Vilaine J-P, et al. Hypercholesterolemia increases coronary endothelial dysfunction, lipid content, and accelerated atherosclerosis after heart transplantation. Arterioscler Thromb Vasc Biol 2000; 20(3): 728–36.

Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 2010; 8(7): 917-32. DOI: 10.1586/erc.10.56

Lee J, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis 2011; 215(2): 281-3. DOI: 10.1016/j.atherosclerosis.2011.01.003

Gue YX, Gorog DA. Importance of Endogenous Fibrinolysis in Platelet Thrombus Formation. Int J Mol Sci 2017; 18(9): 1-15. DOI: 10.3390/ijms18091850

Jiang SZ, Lu W, Zong XF, Ruan HY, Liu Y. Obesity and hypertension. Exp Ther Med 2016; 12(4): 2395-99. DOI: 10.3892/etm.2016.3667

Mayo Clinic, USA. Exercise: A drug-free approach to lowering high blood pressure. Mayo clinic. 2021. Available from: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-bloodpressure/art-20045206#:~:text=Regular%20exercise%20makes%20the%20heart,This%20lowers%20blood%20pressure, accessed 1 July, 2023.

Hayes P, Ferrara A, Keating A, McKnight K, O’Regan A. Physical activity and hypertension. Rev Cardiovasc Med 2022;23(9): 1-13.

Barnes AS. The epidemic of obesity and diabetes: trends and treatments. Tex Heart Inst J 2011; 38(2): 1424.

Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes 2012; 19(2): 81-7. DOI: 10.1097/MED.0b013e3283514e13

Choi JC, Lee JS, Kang SY, Kang JH, Bae JM. Family history and risk for ischemic stroke: sibling history is more strongly correlated with the disease than parental history. J Neurol Sci 2009; 284(1-2): 29-32. DOI: 10.1016/j.jns.2009.03.015

Yan LL, Li C, Chen J, Miranda JJ, Luo R, Bettger J, et al. Prevention, management, and rehabilitation of stroke in low- and middle-income countries. eNeurologicalSci 2016; 2: 21-30. DOI: 10.1016/j.ensci.2016.02.011

Chao BH, Tu WJ, Wang LD; Stroke Prevention Project Committee, National Health Commission of the People's Republic of China. Initial establishment of a stroke management model in China: 10 years (20112020) of Stroke Prevention Project Committee, National Health Commission. Chin Med J (Engl) 2021; 134(20): 2418-20. DOI: 10.1097/CM9.0000000000001856

Chen S, Ma J, Hong J, Chen C, Yang Y, Yang Z, et al. A public health milestone: China publishes new Physical Activity and Sedentary Behaviour Guidelines. Journal of Activity, Sedentary and Sleep Behaviors 2022; 1(1): 1-6.

Rahbar MH, Medrano M, Diaz-Garelli F, Gonzalez Villaman C, Saroukhani S, Kim S, et al. Younger age of stroke in low-middle income countries is related to healthcare access and quality. Ann Clin Transl Neurol 2022; 9(3): 415-27. DOI: 10.1002/acn3.51507

Rajah R, Hassali MAA, Murugiah MK. A systematic review of the prevalence of limited health literacy in Southeast Asian countries. Public Health 2019; 167: 8–15.

Rajah R, Hassali MA, Lim CJ. Health Literacy-Related Knowledge, Attitude, and Perceived Barriers: A Cross-sectional Study among Physicians, Pharmacists, and Nurses in Public Hospitals of Penang, Malaysia. Front Public Health 2017; 5: 1-6.

Institute for Population and Social Research; Mahidol University. Health Behaviors. In Andrew Jonathan Hall: Thai Health 2015: Health Frauds. 1st. Nonthaburi: Ban Tai Soi Design; 2015. 18-20. Available from: https://www.hiso.or.th/hiso/picture/reportHealth/ThaiHealth2015/eng2015_7.pdf, accessed 5 June, 2023.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. DOI: 10.1136/bmj.n71

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Published

2024-08-29