Abstract:
Background: There is a paucity of data on patients with stroke-transient ischaemic attack in low- and middle-income countries. We sought to describe the characteristics and management of patients with an ischaemic stroke and recent transient ischaemic attack or minor ischaemic strokes in low- or middle-income countries. Methods: The Outcomes in Patients with TIA and Cerebrovascular disease registry is an international, prospective study. Patients ≥45 years who required secondary prevention of stroke (either following an acute transient ischaemic attack or minor ischaemic strokes (National Institutes of Health Stroke Scale 4) of 24h duration, or recent (6 months), stable, first-ever, non-disabling ischaemic stroke) were enrolled in 17 countries in Latin America, the Middle East, and Africa. The main measures of interest were risk factors, comorbidities, and socio-economic variables. Results: Between January 2007 and December 2008, 3635 patients were enrolled in Latin America (n=1543), the Middle East (n=1041), North Africa (n=834), and South Africa (n=217). Of these, 63percent had a stable, first-ever ischaemic stroke (median delay from symptom onset to inclusion, 25 days interquartile range, 7-77); 37percent had an acute transient ischaemic attack or minor ischaemic stroke (median delay, two-days; interquartile range, 0-6). Prevalence of diabetes was 46percent in the Middle East, 29percent in Latin America, 35percent in South Africa, and 38percent in North Africa; 72percent had abdominal obesity (range, 65-78percent; adjusted P0·001); prevalence of metabolic syndrome was 78percent (range, 72-84percent, P0·001). Abnormal ankle brachial index (0·9) was present in 22percent, peripheral artery disease in 7·6percent, and coronary artery disease in 13percent. Overall, 24percent of patients had no health insurance and 27percent had a low educational level. Interpretation: In this study, patients in low- and middle-income countries had a high burden of modifiable risk factors. High rates of low educational level and lack of health insurance in certain regions are potential obstacles to risk factor control. Funding: The Outcomes in Patients with TIA and Cerebrovascular disease registry is supported by Sanofi-Aventis, Paris, France. © 2012 World Stroke Organization.