Browsing by Author "Wahab, K."
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Item APOL1, CDKN2A/CDKN2B, and HDAC9 Polymorphisms and Small Vessel Ischemic Stroke(Acta Neurologica Scandinavica, 2018-01) Tiwari, H.K.; Arnett, D.K.; Ovbiagele, B.; Irvin, M.R.; Wahab, K.; Sarfo, F.; Srinivasasainagendra, V.; Adeoye, A.; Perry, R.T.; Akpalu, A.; Jenkins, C.; Arulogun, O.; Gebregziabher, M.; Owolabi, L.; Obiako, R.; Sanya, E.; Komolafe, M.; Fawale, M.; Adebayo, P.; Osaigbovo, G.; Sunmonu, T.; Olowoyo, P.; Chukwuonye, I.; Obiabo, Y.; Onoja, A.; Akinyemi, J.; Ogbole, G.; Melikam, S.; Saulson, R.; Owolabi, M.OBJECTIVE: Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS: Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS: Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION: This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.Item Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project(Mary Ann Liebert Inc., 2018-05) Akinyemi, R.O.; Akinwande, K.; Diala, S.; Adeleye, O.; Ajose, A.; Issa, K.; Owusu, D.; Boamah, I.; Yahaya, I.S.; Jimoh, A.O.; Imoh, L.; Fakunle, G.; Akpalu, A.; Sarfo, F.; Wahab, K.; Sanya, E.; Owolabi, L.; Obiako, R.; Osaigbovo, G.; Komolafe, M.; Fawale, M.; Adebayo, P.; Olowoyo, P.; Obiabo, Y.; Sunmonu, T.; Chukwuonye, I.; Balogun, O.; Adeoye, B.; Oladele, F.; Olowoniyi, P.; Adeyemi, F.; Lezzi, A.; Falayi, A.T.; Fasanya, M.; Ogunwale, K.; Adeola, O.; Olomu, O.; Aridegbe, O.; Laryea, R.; Uvere, E.; Faniyan, M.; Melikam, E.; Tagge, R.; Akpa, O.; Akinyemi, J.; Arulogun, O.; Tiwari, H.K.; Ovbiagele, B.; Owolabi, M.O.Africa was previously insufficiently represented in the emerging discipline of biobanking despite commendable early efforts. However, with the Human, Heredity, and Health in Africa (H3Africa) initiative, biorepository science has been bolstered, regional biobanks are springing up, and awareness about biobanks is growing on the continent. The Stroke Investigative Research and Educational Network (SIREN) project is a transnational, multicenter, hospital and community-based study involving over 3000 cases and 3000 controls recruited from 16 sites in Ghana and Nigeria. SIREN aims to explore and unravel the genetic and environmental factors that interact to produce the peculiar phenotypic and clinical characteristics of stroke as seen in people of African ancestry and facilitate the development of new diagnostics, therapeutics, and preventative strategies. The aim of this article is to describe our experience with the development of the procedure for collection, processing, storage, and shipment of biological samples (blood, serum, plasma, buffy coat, red cell concentrates, and DNA) and brain imaging across coordinating and participating sites within the SIREN Project. The SIREN network was initiated in 2014 with support and funding from the H3Africa Initiative. The SIREN Biobank currently has 3015 brain images, 92,950 blood fractions (serum, plasma, red cell concentrates, and buffy coat) accrued from 8450 recruited subjects, and quantified and aliquoted good-quality DNA extracts from 6150 study subjects. This represents an invaluable resource for future research with expanding genomic and trans-omic technologies. This will facilitate the involvement of indigenous African samples in cutting-edge stroke genomics and trans-omics research. It is, however, critical to effectively engage African stroke patients and community members who have contributed precious biological materials to the SIREN Biobank to generate appropriate evidence base for dealing with ethical, legal, and social issues of privacy, autonomy, identifiability, biorights, governance issues, and public understanding of stroke biobanking in the context of unique African culture, language, and belief systems. © Rufus O. Akinyemi et al. 2018.Item Differential Impact of Risk Factors on Stroke Occurrence Among Men Versus Women in West Africa The SIREN Study(Journal of Cerebral Circulation, 2019-04) Akpalu, A.; Gebregziabher, M.; Ovbiagele, B.; Sarfo, F.; Iheonye, H.; Akinyemi, R.; Akpa, O.; Tiwari, H.K.; Arnett, D.; Wahab, K.; Lackland, D.; Abiodun, A.; Ogbole, G.; Jenkins, C.; Arulogun, O.; Akpalu, J.; Obiako, R.; Olowoyo, P.; Fawale, M.; Komolafe, M.; Osaigbovo, G.; Obiabo, Y.; Chukwuonye, I.; Owolabi, L.; Adebayo, P.; Sunmonu, T.; Owolabi, M.Background and Purpose—The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods—SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results—Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49–71.77) versus 16.1 0(9.19–28.19)], dyslipidemia [2.08 (1.42–3.06) versus 1.83 (1.29–2.59)], diabetes mellitus [3.18 (2.11–4.78) versus 2.19 (1.53–3.15)], stress [2.34 (1.48–3.67) versus 1.61 (1.07–2.43)], and low consumption of green leafy vegetables [2.92 (1.89–4.50) versus 2.00 (1.33–3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%–99.6%) among females with 9 factors accounting for 97.2% (94.9%–98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions—Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region. (Stroke. 2019;50:820-827. DOI: 10.1161/STROKEAHA.118.022786.)Item Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study(The Lancet Global Health, 2018-04) Owolabi, M.O.; Sarfo, F.; Akinyemi, R.; Gebregziabher, M.; Akpa, O.; Akpalu, A.; Wahab, K.; Obiako, R.; Owolabi, L.; Ovbiagele, B.; SIREN Team; H3Africa ConsortiumBackground: Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa. Methods: The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs. Findings: Between Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59·0 years (SD 13·8) for cases and 57·8 years (13·7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six (<1%) had discrete ischaemic and haemorrhagic lesions. 98·2% (95% CI 97·2–99·0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19·36 (95% CI 12·11–30·93) and 90·8% (95% CI 87·9–93·7) for hypertension, 1·85 (1·44–2·38) and 35·8% (25·3–46·2) for dyslipidaemia, 1·59 (1·19–2·13) and 31·1% (13·3–48·9) for regular meat consumption, 1·48 (1·13–1·94) and 26·5% (12·9–40·2) for elevated waist-to-hip ratio, 2·58 (1·98–3·37) and 22·1% (17·8–26·4) for diabetes, 2·43 (1·81–3·26) and 18·2% (14·1–22·3) for low green leafy vegetable consumption, 1·89 (1·40–2·54) and 11·6% (6·6–16·7) for stress, 2·14 (1·34–3·43) and 5·3% (3·3–7·3) for added salt at the table, 1·65 (1·09–2·49) and 4·3% (0·6–7·9) for cardiac disease, 2·13 (1·12–4·05) and 2·4% (0·7–4·1) for physical inactivity, and 4·42 (1·75–11·16) and 2·3% (1·5–3·1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence. Interpretation: Implementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans. Funding: National Institutes of Health. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseItem Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study(Journal of the American Heart Association, 2019-05-30) Akpalu, A.; Adeoye, A.M.; Ovbiagele, B.; Akinyemi, J.O.; Ogah, O.S.; Akinyemi, R.; Gebregziabher, M.; Wahab, K.; Fakunle, A.G.; Akintunde, A.; Adebayo, O.; Aje, A.; Tiwari, H.K.; Arnett, D.; Agyekum, F.; Appiah, L.T.; Amusa, G.; Olunuga, T.O.; Onoja, A.; Sarfo, F.S.; Jenkins, C.; Lackland, D.; Owolabi, L.; Komolafe, M.; Faniyan, M.M.; Arulogun, O.; Obiako, R.; Owolabi, M.Background-—Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results-—We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2 14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions-—Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.Background-—Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results-—We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2 14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions-—Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.Item Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke :A Multicenter Study in West Africa(Global Heart, 2017) Adeoye, A.M.; Ovbiagele, B.; Kolo, P.; Appiah, L.; Aje, A.; Adebayo, O.; Sarfo, F.; Akinyemi, J.; Adekunle, G.; Agyekum, F.; Shidali, V.; Ogah, O.; Lackland, D.; Gebregziabher, M.; Arnett, D.; Tiwari, H.K.; Akinyemi, R.; Olagoke, O.O.; Oguntade, A.S.; Olunuga, T.; Uwanruochi, K.; Jenkins, C.; Adadey, P.; Iheonye, H.; Owolabi, L.; Obiako, R.; Akinjopo, S.; Armstrong, K.; Akpalu, A.; Fakunle, A.; Saulson, R.; Aridegbe, M.; Olowoyo, P.; Osaigbovo, G.; Akpalu, J.; Fawale, B.; Adebayo, P.; Arulogun, O.; Ibinaiye, P.; Agunloye, A.; Ishaq, N.; Wahab, K.; Akpa, O.Background Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. Objectives We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. Methods SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. Results This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age <45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure > 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). Conclusions The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry. © 2017 World Heart Federation (Geneva)Item Frequency and factors associated with post-stroke seizures in a large multicenter study in West Africa(Journal of the Neurological Sciences, 2021) Sarfo, F.S.; Akinyemi, J.; Akpalu, A.; Wahab, K.; Yaria, J.; Adebayo, O.; Komolafe, M.; Obiako, R.; Owolabi, L.; Osaigbovo, G.O.; Jenkins, C.; Mensah, Y.; Ogbole, G.; Calys-Tagoe, B.; Adebayo, A.; Appiah, L.; Singh, A.; Fakunle, A.; Uvere, E.; Hemant, T.; Balogun, O.; Adeleye, O.; Fawale, F.; Abdulwasiu, A.; Ogunjimi, L.; Akinola, O.; Arulogun, O.; Donna, A.; Ogah, O.; Akinyemi, R.; Ovbiagele, B.; Owolabi, M.O.Background: Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. Purpose: To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. Methods: We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/ or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. Results: Among 3344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7–16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p = 0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p = 0.01. The factors associated with PSS occurrence were age < 50 years, aOR of 1.59 (1.08–2.33), National Institute of Health Stroke Score (NIHSS), 1.29 (1.16–1.42) for each 5 units rise and white cell count 1.07 (1.01–1.13) for each 10^3 mm3 rise. Factors associated with PSS in ischemic were NIHSS score, aOR of 1.17 (1.04–1.31) and infarct volume of 10–30 cm3 aOR of 2.17(1.37–3.45). Among ICH, associated factors were alcohol use 5.91 (2.11–16.55) and lobar bleeds 2.22 (1.03–4.82). Conclusion: The burden of PSS among this sample of west Africans is substantial and may contribute to poor outcomes of stroke in this region. Further longitudinal studies are required to understand the impact on morbidity and mortality arising from PSS in Africa.Item Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa(Journal of the Neurological Sciences, 2021) Sarfo, F.S.; Akpa, O.; Ovbiagele, B.; Akpalu, A.; Wahab, K.; Komolafe, M.; Obiako, R.; Owolabi, L.; Osaigbovo, G.O.; Jenkins, C.; Adekunle Fakunle, A.; Ogbole, G.; Tiwari, H.K.; Arulogun, O.; Arnett, D.K.; Asowata, O.; Ogah, O.; Akinyemi, R.O.; Owolabi, M.O.Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50–65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82–71.58) and 4.13 (2.64–6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82–96.80) and aOR of 28.93 (15.10–55.44) was highest among the middle-age group. Diabetes with PAR of 32.29% (27.52–37.05) and aOR of 3.49 (2.56–4.75); meat consumption with PAR of 42.34%(32.33–52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02–21.60) and aOR of 2.23 (1.60–3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivityItem Interleukin–6 (IL-6) Rs1800796 and Cyclin Dependent Kinase Inhibitor (CDKN2A/CDKN2B) Rs2383207 are Associated with Ischemic Stroke in Indigenous West African Men(Journal of the Neurological Sciences, 2017-05) Akinyemi, R.; Arnett, D.K.; Tiwari, H.K.; Ovbiagele, B.; Sarfo, F.; Srinivasasainagendra, V.; Irvin, M.R.; Adeoye, A.; Perry, R.T.; Akpalu, A.; Jenkins, C.; Owolabi, L.; Obiako, R.; Wahab, K.; Sanya, E.; Komolafe, M.; Fawale, M.; Adebayo, P.; Osaigbovo, G.; Sunmonu, T.; Olowoyo, P.; Chukwuonye, I.; Obiabo, Y.; Akpalu, O.; Melikam, S.; Saulson, R.; Kalaria, R.; Ogunniyi, A.; Owolabi, M.BACKGROUND: Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin-6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. AIM: Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. METHODS: Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men=198; Women=231) and stroke- free (N=483) controls (Men=236; Women=247). RESULTS: Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans=8.6%) was significantly associated with ischemic stroke in men (OR=2.006, 95% CI=[1.065, 3.777], p=0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans=1.7%) was also associated with ischemic stroke in men (OR=2.550, 95% CI=[1.027, 6.331], p=0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. CONCLUSION: Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry.Item Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression(SAGE, 2022) Ojagbemi, A.; Akinyemi, J.; Wahab, K.; Owolabi, L.; Arulogun, O.; Akpalu, J.; Akpalu, A.; Ogbole, G.; Akinsanya, C.; Wasiu, A.; Tito-Ilori, M.; Adekunle, F.; Lyrea, R.; Akpa, O.; Akinyemi, R.; Sarfo, F.; Owolabi, M.; Ovbiagele, B.Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa. Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression (“HRQOLISP-E”). Independent associations were investigated using complementary log-log regression and binary logit models. Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR ¼ 2.22, 95% CI ¼ 1.37-3.56) and low consumption of green leafy vegetables (OR ¼ 1.91, 95% CI ¼ 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD. Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.Item Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans(Global Heart, 2017) Adeoye, A.M.; Ogah, O.S.; Ovbiagel, B.; Akinyemi, R.; Shidali, V.; Agyekum, F.; Aje, A.; Adebayo, O.; Akinyemi, J.O.; Kolo, P.; Appiah, L.T.; Iheonye, H.; Kelechukwu, U.; Ganiyu, A.; Olunuga, T.O.; Akpa, O.; Olagoke, O.O.; Sarfo, F.S.; Wahab, K.; Olowookere, S.; Fakunle, A.; Akpalu, A.; Adebayo, P.B.; Nkromah, K.; Yaria, J.; Ibinaiye, P.; Ogbole, G.; Olumayowa, A.; Lakoh, S.; Calys-Tagoe, B.; Olowoyo, P.; Innocent, C.; Tiwari, H.K.; Arnett, D.; Godwin, O.; Ayotunde, B.; Akpalu, J.; Obiora, O.; Joseph, O.; Omisore, A.; Jenkins, C.; Lackland, D.; Owolabi, L.; Isah, S.; Dambatta, A.H.; Komolafe, M.; Bock-Oruma, A.; Melikam, E.S.; Imoh, L.C.; Sunmonu, T.; Gebregziabher, M.; Olabisi, O.; Armstrong, K.; Onyeonoro, U.U.; Sanya, E.; Agunloye, A.M.; Ogunjimi, L.; Arulogun, O.; Farombi, T.H.; Obiabo, O.; Obiako, R.; Owolabi, M.Background Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans. Objectives The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. Methods We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). Results Patients' mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). Conclusions About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability. © 2017 World Heart Federation (Geneva)