Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania A Community-Based Case–Control Study

Authors

Quirijn de Mast, Radboud University Medical, Netherlands
Jessica E. Molhoek, Radboud University Medical Center The Netherlands
André J. van der Ven, Radboud University Medical Center, The Netherlands
William K. Gray, Radboud University Medical Center, The Netherlands
Philip G. de Groot, Radboud University Medical Center, The Netherlands
Ahmed Jusabani, Aga Khan UniversityFollow
Ferdinand Mugusi, Radboud University Medical Center, The Netherlands
Rolf T. Urbanus, Radboud University Medical Center, The Netherlands
Richard W. Walker, Radboud University Medical Center, The Netherlands

Document Type

Article

Department

Imaging and Diagnostic Radiology (East Africa)

Abstract

Background and Purpose

The burden of stroke is high in sub-Saharan Africa, and improved knowledge of risk factors is needed. Antiphospholipid antibodies are a common acquired stroke risk factor in young individuals. Antiphospholipid antibodies may be induced by infectious diseases. Sub-Saharan Africa has a high infectious burden, and we analyzed the contribution of antiphospholipid antibodies to the risk of stroke in an incident population from rural and urban Tanzania.

Methods Stroke cases and age- and sex-matched community-acquired controls from the rural Hai district and urban Dar-es-Salaam areas of Tanzania were recruited in a wider study of stroke incidence between June 2003 and June 2006. Lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I, and antiphosphatidylserine/prothrombin antibodies were determined in stored plasma, as well as IgG antibodies against Treponema pallidum.

Results

Data from 158 stroke cases and 369 controls were analyzed. Thirty cases (19%) and 4 controls (1%) had a lupus anticoagulant (odds ratio, 20.8; 95% confidence interval, 7.2–60.5). Anticardiolipin IgG was the only other antiphospholipid antibody subtype associated with increased stroke risk (odds ratio, 2.1; 95% confidence interval, 1.0–4.3), but this association disappeared when corrected for IgG antibodies against Treponema pallidum results. The prevalence of anti-β2-glycoprotein I IgG antibodies in the Tanzanian healthy population was high when Dutch cutoff values were applied (67%), whereas presence of anti-β2-glycoprotein I IgM was associated with a reduced stroke risk (odds ratio 0.3; 95% confidence interval, 0.1–1.1).

Conclusions

The presence of lupus anticoagulant is a strong, and to date unrecognized, risk factor for stroke in Tanzania, especially in young and middle-aged individuals.

Comments

his work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Stroke

Recommended Citation

de Mast, Q., Molhoek, J. E., van der Ven, A. J., Gray, W. K., de Groot, P. G., Jusabani, A., ... & Walker, R. W. (2016). Antiphospholipid Antibodies and the Risk of Stroke in Urban and Rural Tanzania: A Community-Based Case–Control Study. Stroke, 47(10), 2589-2595.