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INTERSTROKE (Canada): Importance of Conventional and Emerging Risk Factors for Stroke in Different Regions of the World and in Different Ethnic Groups.
Guillaume Paré, McMaster University
Salim Yusuf , McMaster University
Philip Teal, University of British Columbia
Moira Kapral, University of Toronto
Ashfaq Shuaib, University of Alberta
David Gladstone, University of Toronto
Gordon Gubitz, Dalhousie University
Frank Silver, University of Toronto
Mike Sharma, University of Ottawa
Stroke is a major global public health problem. The overall purpose of INTERSTROKE is to learn about the role of known risk factors, such as high blood pressure, and emerging risk factors, such as genetics, for stroke in different regions of the world and ethnic groups. Members of the project team completed a similar study for myocardial infarction (MI). INTERHEART included 30,000 participants from 52 countries and showed that 9 modifiable risk factors accounted for over 90% of the risk. A similar study is necessary in stroke because:
- the causes of stroke are far more diverse than MI;
- many of the common risk factors for stroke and MI (e.g. lipids) appear to exert very different magnitudes of risk for stroke compared with MI, and;
- there are limited epidemiological studies in stroke.
This study compares risk factors in people with stroke (cases) to people without stroke (controls) in a large, international case-control study that includes approximately 30,000 cases and controls from about 32 countries. Countries will recruit the following ethnic groups: Caucasians, Chinese, South Asians, Africans and native South Americans. The pilot phase of INTERSTROKE, involving 8 countries, started in March 2007 and recruitment was to be completed in July 2008 (3,200 patients). The pilot phase, funded by the Canadian Institutes of Health Research, included 220 case-control pairs from Canada. Upon completion of the pilot phase of the study, there will be a transition into the full-scale study. For the full study, CSN funding enables recruitment of a further 880 pairs (total of 1,000 pairs) over 3 years from Canadian sites (6 sites).
INTERSTROKE will provide essential information on conventional and emerging risk factors that will guide population-based interventions to reduce the risk of stroke in Canada. INTERSTROKE will involve national and international collaboration. Central coordination of the study will be at McMaster University. The control group in INTERSTROKE-Canada will also serve as a cohort for completion of an imaging study to determine the prevalence and determinants of silent brain infarction. INTERSTROKE will have enormous implications for our understanding of the causes of stroke within Canada and around the world. It will also provide key information to help guide population health initiatives aimed at preventing stroke in low and high-income countries.