Background: Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries. Summary: We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial (n = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both p ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; p = 0.07). Key Messages: Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.

Leys D: Atherothrombosis: a major health burden. Cerebrovasc Dis 2001;11(suppl 2):1-4.
Murray CJ, Lopez AD: Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-1276.
Murray CJ, Lopez AD, Chin B, Feehan D, Hill KH: Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis. Lancet 2006;368:2211-2218.
Abboud H, Labreuche J, Arauz A, Bryer A, Lavados PG, Massaro A, et al: Demographics, socio-economic characteristics, and risk factor prevalence in patients with non-cardioembolic ischaemic stroke in low- and middle-income countries: the OPTIC registry. Int J Stroke 2013;8(suppl A100):4-13.
Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, et al: Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014;45:315-353.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009;8:355-369.
EUROASPIRE II Study Group: Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 2001;22:554-572.
Bousser MG, Amarenco P, Chamorro A, Fisher M, Ford I, Fox K, et al: The prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study: baseline characteristics of the population. Cerebrovasc Dis 2009;27:608-613.
Ghali WA, Quan H, Brant R, van Melle G, Norris CM, Faris PD, et al: Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models. JAMA 2001;286:1494-1497.
Amarenco P, Abboud H, Labreuche J, Arauz A, Bryer A, Lavados PM, et al: Impact of living and socioeconomic characteristics on cardiovascular risk in ischemic stroke patients. Int J Stroke 2014;9:1065-1072.
Tran J, Mirzaei M, Anderson L, Leeder SR: The epidemiology of stroke in the middle East and North Africa. J Neurol Sci 2010;295:38-40.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003;289:2363-2369.
Addo J, Smeeth L, Leon DA: Hypertension in sub-saharan Africa: a systematic review. Hypertension 2007;50:1012-1018.
Badran M, Laher I: Type II diabetes mellitus in Arabic-speaking countries. Int J Endocrinol 2012;2012:902873.
Rahim HF, Sibai A, Khader Y, Hwalla N, Fadhil I, Alsiyabi H, et al: Non-communicable diseases in the Arab world. Lancet 2014;383:356-367.
Meyer BF, Alsmadi O, Wakil S, Al-Rubeaanb K: Genetics of type 2 diabetes in Arabs: what we know to date. Int J Diabetes Mellitus 2009;1:32-34.
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al: Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183-192.
Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T: Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tob Control 2004;13:327-333.
Bush J, White M, Kai J, Rankin J, Bhopal R: Understanding influences on smoking in Bangladeshi and Pakistani adults: community based, qualitative study. BMJ 2003;326:962.
Muller-Nordhorn J, Nolte CH, Rossnagel K: Knowledge about risk factors for stroke: a population-based survey of 28,090 participants. Stroke 2006;37:946-950.
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