engleski

Regional differences in burden of risk factors for stroke in Croatia: a 254 three-center study

BACKGROUND/OBJECTIVE: Regional diversities in stroke mortality were observed within the Croatian population: continental parts of Croatia (Zagreb and Osijek) had higher stroke mortality rates than the standardized stroke mortality rate in Croatia, while the coastal part (Split) had a lower one. Regional differences in identification and treatment of major risk factors for stroke may contribute to a different outcome of stroke. We made a comprehensive clinical-based study to analyze the burden of risk factors for patients at the hospital admission in three major regional stroke centers in Croatia, and to give guidelines for primary and secondary prevention of stroke in the affected populations. METHODS: We analyzed three groups of patients hospitalized for stroke during 1 2 consecutive months at neurological departments in Zagreb (138 patients with ischemic and 70 with hemorrhagic stroke), Osijek (191 ischemic and 43 hemorrhagic stroke cases) and Split (204 ischemic and 41 hemorrhagic stroke cases). Diagnoses of stroke subtypes were established on the basis of history data, clinical features and neuroimaging criteria. Medical charts data and laboratory findings were used to detect five major endogenous risk factors for stroke (hypertension, diabetes, heart diseases, elevated blood cholesterol and triglycerides) in the examined populations. RESULTS: Each subject in both Zagreb and Osijek had an average of 1.7 of above mentioned risk factors for stroke in comparison to 0.9 per subject in Split. Hypertension was a leading risk factor for both ischemic and hemorrhagic stroke in Osijek and Split, while in Zagreb it was the most frequent one for hemorrhagic stroke only. In Osijek and Zagreb hypertension was found in more than twice as much in ischemic stroke patients than in Split (65.2% for Zagreb and Osijek patients vs. 29.9% for Split patients, p<0.005); this difference also remained significant for hemorrhagic stroke between Osijek and Zagreb vs. Split patients (Zagreb 77.1%, Osijek 79.11/9, Split 46.3%). We found following frequencies of risk factors for ischemic stroke in Zagreb: heart diseases to be more frequent than hypertension (69.6%), followed by the elevated cholesterol (25.2%), diabetes (21 %) and triglycerides (1 4.8%); in Osijek: hypertension was followed by hypercholesteremia (42.5%), hypertriglyceridemia (34.2%), heart diseases (28,7%) and diabetes (21 %); in Split: hypertension followed by heart diseases ( 26.5%), diabetes (18.1%), blood cholesterol (13.6%) and triglycerides (9%). The most frequent risk factors associated with hemorrhagic stroke after hypertension were as follows: in Zagreb cholesterol (46.5%), heart diseases (31.4%), triglycerides (11.6%) and diabetes (4.3%), in Osijek cholesterol (37.9%), triglycerides (27.6%), heart diseases (1 1.6%) and diabetes (4.7%), in Split cholesterol (7,4%), heart diseases (7.3%), triglycerides (3.7%) and diabetes (2.4%). CONCLUSION: We found a different pattern of the burden of risk factors for stroke in the continental part of Croatia (Zagreb and Osijek) and the coastal part (Split). Higher mortality rate of both ischemic and hemorrhagic stroke in Zagreb and Osijek vs. Split may be related to the higher proportion of hypertension and dyslipidemia in the continental Croatia, and in case of ischemic stroke to the greater occurrence of heart diseases (in the Zagreb region). This can be attributed to regional diversities in diet (saturated vs. unsaturated fatty acids, salt and alcohol consumption), climate and the sociocultural background.

risk factors; stroke

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