Original Paper Med Princ Pract 2003;12:218–223 DOI: 10.1159/000072287 Risk Factors, Subtypes and Outcome of Ischaemic Stroke in Kuwait – A Hospital-Based Study S. Al-Shammri a,b,c Z. Shahid b A. Ghali b M.M. Mehndiratta a T.R. Swaminathan c G. Chadha c P.N. Sharma d A.O. Akanji e a Department of Medicine, Faculty of Medicine, Kuwait University, b Kuwait Oil Company Hospital, c Mubarak Al-Kabir Hospital, Ministry of Health, d Health Sciences Computer Centre and e Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait Received: August 11, 2002 Revised: April 8, 2003 Dr. Suhail Al-Shammri Department of Medicine Faculty of Medicine, Kuwait University PO Box 24923, Safat 13110 (Kuwait) Tel. +965 531 9596, Fax +965 533 8907, E-Mail suhail@hsc.kuniv.edu.kw ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2003 S. Karger AG, Basel 1011–7571/03/0124–0218$19.50/0 Accessible online at: www.karger.com/mpp Key Words Stroke W Stroke subtypes W Risk factors W Atherosclerosis W Kuwait Abstract Objective: To report on stroke subtypes, associated risk factors and outcome in Kuwait. Methods: The records of 62 patients (30 male, 32 female) admitted with diagnosis of stroke to Kuwait Oil Company Hospital, Kuwait, a ter- tiary care hospital, during a 5-year period (1995–1999), were retrospectively reviewed. Results: Small artery in- farction was the most common subtype and occurred in 37 subjects (59.7%); less common were atherosclerotic large artery strokes (19 patients, 30.6%) and strokes of cardio-embolic origin (6 patients, 9.7%). Identifiable risk factors or associated morbidities were hypertension (72.5%), diabetes mellitus (69.4%), ischaemic heart dis- ease (14.5%), history of migraine (8.1%), lone atrial fibril- lation (5.0%), and valvular heart disease (1.6%). The most important determinants of a deleterious 30-day outcome, as indicated by severe disability or death, were female gender, lack of use of anti-platelet drugs, pres- ence of a large artery infarction stroke subtype, and car- dio-embolic stroke. Conclusion: Prevalence of hyperten- sion and diabetes is high among patients with stroke in Kuwait, with rates higher than those found in any pre- vious reports from the Gulf region. Two unusual obser- vations were that women had a rather high frequency of stroke, and infarction of the small artery was more com- mon than that of the large artery. Outcome, as indicated by severe disability or death, was worse among women, elderly patients, and those with large artery atheroscle- rotic and cardio-embolic strokes. There is some evidence that such a deleterious outcome might be ameliorated with use of anti-platelet drugs. Copyright © 2003 S. Karger AG, Basel Introduction Stroke is an important cause of hospital admissions and long-term disability in most countries. It ranks as the third leading cause of death in developed countries after ischaemic heart disease and cancer [1]. However, in recent times, the incidence of stroke and subsequent mor- tality appear to have decreased in industrialised coun- tries, probably due to better control of the associated risk factors and improved acute care resources [2]. Most stud- ies indicate that arterial hypertension is the major risk factor for stroke, irrespective of gender and race; other important recognised risk factors are diabetes mellitus,