Grant: Operating Grant

Stroke is a major public health problem that contributes significantly to the global burden of disease. Stroke is the third leading cause of death worldwide (after coronary heart disease and cancer), and accounted for 9.5% of all deaths in 1999, two-thirds of which occurred in the developing world. Phase 1 of the INTERSTROKE study was completed in April 2010, included 6,000 participants from 22 countries (published in Lancet 2010). Phase 1 provided preliminary findings and suggested that ten risk factors accounted for 90% of the population-attributable risk for stroke, namely hypertension, smoking, physical inactivity, diet, abdominal obesity, psychosocial factors, apolipoproteins, diabetes mellitus and atrial fibrillation. However, the importance of these risk factors within individual regions remains unclear, but is essential information for regional and national health authorities to develop Stroke Prevention Programs. Moreover, the importance of novel risk factors (particularly genetics) is not known, but presents an important research question that may lend important insights into mechanism of disease and potential therapeutic targets. In Phase 2 of INTERSTROKE, we will include 30,000 people (15,000 with stroke and 15,000 without stroke) and determine the importance of risk factors within regions and different stroke subtypes. In addition, we will determine whether genetics (and other suspected factors) are associated with an increased risk of stroke.