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Risk Factors of Stroke in Western and Asian Countries: A Systematic Review and Meta-analysis of Prospective Cohort Studies

Xuetao Chen12, Liang Zhou1, Yanqi Zhang1, Dali Yi1, Ling Liu1, Wen Rao3, Yazhou Wu1, Dihui Ma1, Xiaoyu Liu1, Xiao-Hua Andrew Zhou4, Hui Lin5, Dixiang Cheng6 and Dong Yi1*

Author Affiliations

1 Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, PO Box 400038, Chongqing, China

2 Department of Information, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Chongqing 400037, China

3 Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, China

4 Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle 98124-6108, USA

5 Department of Epidemiology, Institute of tropical medicine, Third Military Medical University, Chongqing 400038, China

6 School of Software Engineering, Chongqing University of Posts and Telecommunications, Chongqing 400065, China

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BMC Public Health 2014, 14:776  doi:10.1186/1471-2458-14-776

Published: 31 July 2014



There has been an increasing trend in the incidence of stroke worldwide in recent years, and the number of studies focusing on the risk factors for stroke has also increased every year. To comprehensively evaluate the risk factors of stroke identified in prospective Western and Asian cohort studies.


Population-based cohort studies on stroke were searched in databases (PubMed, EMBASE, Web of Science, Google Scholar, etc.), and the library of the Third Military Medical University was manually searched for relevant information. A meta-analysis of Western and Asian studies on risk factors was performed. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the final group of cohort studies.


After screening, 22 prospective cohort studies were included in the analyses of this investigation. Two factors, smoking and alcohol consumption, showed statistically significant differences between Western and Asian populations, and the results were as follows (W/A): 2.05 (95% CI, 1.68 ~ 2.49)/1.27 (95% CI, 1.04 ~ 1.55) and 0.89 (95% CI, 0.76 ~ 1.04)/1.28 (95% CI, 1.07 ~ 1.53). The factor BMI = 18.5-21.9 kg/m2 showed statistically significant differences only in Western populations, 0.96 (95% CI, 0.93 ~ 0.99); the factor SBP = 120-139 mm Hg showed statistically significant differences only in Asian populations, 2.29 (95% CI, 1.04 ~ 5.09).


The prevalences of risk factors affect the stroke morbidity in Western and Asian populations, which may be biased by race. The meta-analysis of population-based studies suggests that different preventive measures should be adopted for Western and Asian population groups that are at high risk for stroke.

Stroke; Risk factors; Prospective study; Epidemiology; Systematic review; Public health