MULTISYSTEM DETERMINANTS OF ISCHAEMIC STROKE IN A POPULATION-BASED COHORT

Abstract

Background: Ischaemic stroke (IS) is a major cause of mortality, disability, and long-term neurological impairment and arises from the interaction of multiple demographic, behavioural, cardiovascular, metabolic, inflammatory, and systemic factors. Identifying the relative contribution of these determinants is essential for improving risk stratification and prevention strategies.

Objective: This review synthesized evidence from population-based cohort studies to characterize the major multisystem determinants associated with incident ischemic stroke and to assess the relative strength of associations across demographic, socioeconomic, behavioral, cardiometabolic, lipid-related, inflammatory, and systemic inflammatory conditions.

Methods: We analysed population-based prospective cohort studies and longitudinal healthcare databases that evaluated incident ischemic stroke in persons who had not previously had a stroke. Evidence from cohorts in Sweden, China, and Taiwan was reviewed, including the Malmö Diet and Cancer Study, the Tianjin Brain Study, and a countrywide Taiwanese cohort of Behçet's illness patients. Hazard ratios, risk estimates, incidence rate ratios, and adjusted regression analyses were used to assess the relationships between possible risk factors and ischaemic stroke.

Results: Advancing age showed a strong dose-dependent association with ischemic stroke, with hazard ratios increasing from 2.4 among individuals aged 35-44 years to 23.9 among those aged ≥75 years compared with participants younger than 35 years. Men had a higher estimated risk than women (HR=1.8). Lower educational attainment, smoking, and high alcohol intake were linked to an increased stroke risk. Higher apolipoprotein B and the ApoB/ApoA1 ratio were positively associated with ischaemic stroke, while higher ApoA1 was negatively correlated. Inflammatory and hematological markers, such as total leukocyte count, neutrophils, neutrophil-to-lymphocyte ratio, suPAR, C-reactive protein, and fibrinogen, revealed positive relationships; however, lymphocyte count indicated an inverse relationship. Takayasu arteritis (~7.40) had the highest documented connection with stroke risk, followed by Behçet's illness (~2.78) and systemic lupus erythematosus (~2.20).

Conclusion: Ischaemic stroke is a multifactorial and multisystem vascular illness caused by a combination of demographic, behavioural, cardiometabolic, inflammatory, and systemic vascular risk factors. Cardiovascular and metabolic variables were very strongly linked, while inflammatory biomarkers and systemic inflammatory disorders provided further information on vascular risk. Comprehensive preventative measures that include control of modifiable cardiometabolic and behavioural factors, as well as awareness of systemic inflammatory disorders, may improve the identification and reduction of populations at high risk of ischaemic stroke.