Kolbasin P.N., Mahkamova Z.R., Bobkov O.V., Severinov S.I., Kazyuta T.G.

Crimea State Medical University named after S. I. Georgievsky

Epidemiological studies of risk factors of ischemic stroke

In recent years, the problem of prevention of ischemic stroke is attracting increasing attention. This is due to the fact that, despite all the advances of pharmacology and the numerous clinical studies on primary and secondary prevention of severe cardiovascular outcome, it maintains its position as the second leading cause of death and a major cause of persistent disability in both industrialized and developing countries. Each year, stroke kills more than 5 million lives, and it accounts for almost a third of all cardiovascular deaths. Another 15 million people who survive a stroke, but about two-thirds of them are disabled. According to epidemiological data, every fifth patient survivor takes repeated ischemic stroke within 5 years after the first. Everything in the world there are more than 50 million patients undergoing first stroke and fearful to die from second. Are extremely high and the economic losses associated with stroke. The annual direct and indirect costs of his treatment are estimated at tens of billions of dollars.

Unfortunately, in the world there are adverse trends in the prevalence of factors predisposing to stroke, no full-fledged programs for its prevention, the population of ill-informed about the risk factors and symptoms of stroke, threatening its development. Doctors do not spend the necessary measures for the prevention of stroke or make a wrong destination. As a result, the constantly increasing gap between the potential and actual achievements in the prevention of stroke. This is all the more unfortunate that almost all points of view, ischemic stroke is an extremely winning facility for preventive interventions. The disease is characterized by a high prevalence, is associated with a dramatic decline in the quality of life and significant economic losses, its main risk factors fairly well defined and generally amenable to modification, effective preventive measures. Thus, according to the American Stroke Association, to its risk factors should include hypertension, hyperlipidemia, myocardial infarction, atrial fibrillation, diabetes mellitus, atherosclerotic disease of the carotid arteries, as well as smoking, alcohol abuse, weakness, unbalanced diet. Almost all of them, in varying degrees, to correct.

According to the register of stroke in our country hypertension observed in 89.2% of stroke patients. In other countries, there is less high incidence of hypertension in stroke patients, for example, in South America; the figure is 71% (A. Pieri, 2008).

In patients with stroke, reducing high blood pressure significantly reduces the risk of stroke, myocardial infarction and other cardiovascular diseases, and the degree of risk reduction is directly dependent on the degree of blood pressure reduction.

A necessary step for the development of a system of adequate preventive and curative care is a preliminary study of the epidemiology of diseases. Unfortunately, the analysis of the incidence and mortality from cerebrovascular disease makes people critical of the available data, since not all countries maintain a register of stroke, do not respect the principle of uniformity of statistical approaches to the analysis of morbidity, mortality, assessing the significance of risk factors. However, these data allow each region to plan and improve the existing arrangements for the provision of medical care in stroke, as well as to develop an effective system of prevention.

To study the clinical and epidemiological parameters and the leading risk factors for cerebral stroke in an open population of the inhabitants of the world and identify key areas to improve primary and secondary prevention of stroke. Objectives of the study.

1. The method of population register studies the epidemiology of stroke in the world.

2. To identify the main risk factors associated with the development of cerebral stroke in the study population , as well as the frequency of their occurrence by sex and age, analyzed the differences and similarities of the data obtained with the nation-wide indicators and indicators of neighboring regions.

3. Set the importance of risk factors in the development of cerebral stroke and disease outcomes by gender and age.

4. Develop guidelines and best practices of primary and secondary prevention of cerebral stroke in the region based on identified risk factors.

The most common risk factors for cerebral stroke in the study population , regardless of gender, are hypertension (96.8 %) , heart disease ( 43.6 %) , dyslipidemia ( 41.7 %) , cardiac arrhythmia ( 23.8 % ) . In men, the risk factor is smoking in all age groups ( 64.4 %). Significant risk factors for the development of re- Chi are hypertension ( 99.6 % of cases) , heart rhythm disturbances 36.8 %) and the presence of a history of myocardial infarction (13.2 % ), with no significant differences among males and females. The outcome of the disease, regardless of age and gender affect arterial hypertension (100 %) in the male population - smoking ( 62.1 %) , history of myocardial infarction ( 16.2 %) in the female population - heart disease (52.3 % ), diabetes ( 12.8 %).

In assessing the primary prevention of ischemic stroke in the world by logistic regression analysis proved the importance of hypertension , heart disease , presence of dyslipidemia and smoking on the risk of ischemic stroke and efficacy of antihypertensive , antiplatelet , lipid-lowering therapy in patients "high risk" of cerebrovascular disease.

Secondary prevention of ischemic stroke in a comprehensive way, according to the pathogenetic subtype of stroke, operative method ( CEA ) , significantly reduces the cases of recurrent acute ischemic attacks 3 times.