Prevalence of Stroke and Associated Risk Factors in Older Adults in Havana City and Matanzas Provinces, Cuba (10/66 Population-Based Study)

Abstract

INTRODUCTION: Cerebrovascular disease (CVD) is the third cause of death and second cause of disability and dementia in adults aged>or=65 years worldwide. The few epidemiological studies of stroke in Latin America generally report lower prevalence and different patterns than developed countries. OBJECTIVE: Estimate the prevalence of stroke and associated risk factors in adults aged>or=65 years in Havana City and Matanzas provinces, Cuba. METHODS: Single phase, cross-sectional, door-to-door study of 3015 adults aged>or=65 years in selected municipalities of Havana City and Matanzas provinces. Variables studied were age, sex, educational level, and self-report and description of chronic disease (stroke, heart attack, angina, and diabetes mellitus), substance use (alcohol, tobacco), and dietary habits. Respondents were given a structured physical and neurological exam, and blood pressure was measured. Laboratory tests comprised complete blood count, fasting glucose, total cholesterol and fractions, triglycerides, and apolipoprotein E (APOE) genotype. Diagnosis of stroke was based on the World Health Organization's definition. Stroke prevalence ratios (crude and adjusted), with 95% confidence intervals (CI), were calculated for the variables studied using a Poisson regression model. Risk association was analyzed using multiple logistic regression for dichotomous responses. RESULTS: Assessments were made of 2944 older adults (97.6% response rate). Prevalence of stroke was 7.8% (95% CI 6.9-8.8), and was higher in men. The risk profile for this population group included history of hypertension (OR 2.8; 95% CI 2.0-4.0), low HDL cholesterol (OR 2.6; 95% CI 1.7-3.9), male sex (OR 1.7; 95% CI 1.2-2.5), anemia (OR 1.6; 95% CI 1.1-2.5), history of ischemic heart disease (OR 1.5; 95% CI 1.0-2.3), carrier of one or two apolipoprotein E4 genotype (APOE E4) alleles (OR 1.4; 95% CI 1.0-2.0), and advanced age (OR 1.3; 95% CI 1.1-1.9). CONCLUSIONS: Stroke prevalence in this study is similar to that reported for Europe and North America, and higher than that observed in other Latin American countries. The risk profile identified includes classic risk factors plus anemia and APOE E genotype.