Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study

Background and Purpose: Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. Methods: A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. Results: A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 +/- 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P < .001) with cardioembolic strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P < .001) in cardioembolic stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P < .001) associated with improved neurological status at discharge (82.6%) when compared to patients aged 45-70 years (78.5%) and more than 70 years (63.8%). Similar findings were observed at 6 months follow-up (78.4% versus 72.8% and 46%; P < .001). Cardioembolic stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P < .061) in large-vessel and small-vessel strokes, respectively. Conclusions: Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome.