Volume 2, Issue 2, No.1 PDF DOWNLOAD
  • Title:
  • Using decision trees to predict stroke risk factors
  • Author:

    Luís Rafaeli Coutinho1*, Josenilton da Silva Nascimento2, Hidelbrando Ferreira Rodrigues3

  • Author Affiliation:

    1.Federal University of Santa Catarina, Florianopolis, Brazil

    2.Florianopolis School of Public Health, Florianopolis, Brazil

    3.Federal University of Manaus, Itacoatiara, Brazil

  • Received:Aug.20, 2023
  • Accepted:Oct.10, 2023
  • Published:Oct.31, 2023
Abstract
Stroke remains one of the main causes of disability and mortality in the world with complex socioeconomic consequences. Stroke is a heterogeneous disease with multiple causes, risk factors, contexts and additives to be researched. The residual effects of stroke have a negative impact on the quality of life by limiting physical, social and emotional health. Both for people with stroke and for their families and caregivers. Primary stroke prevention should expand actions to reduce risk factors that may be modifiable. This study provides an estimate by using the decision tree algorithm of stroke risk factors in the context of Primary Health Care in a survey carried out with the population of a Health Center located in the South region of Brazil. It aimed to identify predisposing factors to the risk of stroke, and to raise awareness about risk factors aimed at prevention. Lifestyle changes and a routine of healthy habits can reduce risk factors and the chances of a stroke. Public prevention policies should consider risk factors as a basis for discussing effective preventive measures and possible future directions in disease care. To improve primary prevention with specific strategies, depression and sleep quality require an in-depth investigation of their mechanisms in the development of stroke. Emerging technologies have the potential to collaborate with prevention.
Keywords

Disease prevention, primary health care, risk factors, stroke.

References

[1] J. Addo et al., “Socioeconomic status and stroke,” Stroke, vol. 43, no. 4, pp. 1186–1191, Apr. 2012. doi:10.1161/strokeaha.111.639732

[2] A.-H. Patomella et al., “Primary prevention of stroke: Randomised controlled pilot trial protocol on engaging everyday activities promoting health,” BMJ Open, vol. 9, no. 11, Nov. 2019. doi:10.1136/bmjopen-2019-031984

[3] M. P. Driga et al., “The need for new biomarkers to assist with stroke prevention and prediction of post-stroke therapy based on plasma-derived extracellular vesicles,” MDPI, https://www.mdpi.com/2227-9059/9/9/1226 (accessed Jun. 25, 2023).Biomedicines. 2021 Sep;9(9):1226. DOI: 10.3390/biomedicines9091226. PMID: 34572411; PMCID: PMC8466486.

[4] Y. Guo, “A new paradigm of ‘real-time’ stroke risk prediction and integrated care management in the Digital Health Era: Innovations Using Machine Learning and Artificial Intelligence Approaches,” Thrombosis and Haemostasis, https://www.thieme-connect.com/products/ejournals/html/10.1055/a-1508-7980 (accessed Jun. 25, 2023).

[5] M. Wang et al., “Associations of genetic susceptibility and healthy lifestyle with incidence of coronary heart disease and stroke in individuals with hypertension,” European Journal of Preventive Cardiology, vol. 29, no. 16, pp. 2101–2110, Jul. 2022. doi:10.1093/eurjpc/zwac135 

[6] C. Ju et al., “Privacy-preserving technology to help millions of people: Federated prediction model for stroke prevention,” arXiv.org, https://arxiv.org/abs/2006.10517 (accessed Aug. 6, 2023).

[7] M. R. Azarpazhooh, C. Bogiatzi, and J. D. Spence, “Stroke prevention: Little-known and neglected aspects,” Cerebrovascular Diseases, vol. 50, no. 6, pp. 622–635, 2021. doi:10.1159/000515829

[8] L, Xi et al. Quality of primary health care in China: challenges and recommendations. The Lancet, v. 395, n. 10239, p. 1802-1812, 2020.

[9] O. Adeoye et al., “Correction to: Recommendations for the establishment of stroke systems of care: A 2019 update: A policy statement from the American Stroke Association,” Stroke, vol. 51, no. 4, pp. e187–e210, Apr. 2020. doi:10.1161/str.0000000000000225

[10] Y. V. Kalkonde, S. Alladi, S. Kaul, and V. Hachinski, “Stroke prevention strategies in the developing world,” Stroke, vol. 49, no. 12, pp. 3092–3097, Dec. 2018. doi:10.1161/strokeaha.118.017384

[11] S. C. Ouriques Martins et al., “Priorities to reduce the burden of stroke in Latin American countries,” The Lancet Neurology,vol. 18, no. 7, pp. 674–683, Jul. 2019. doi:10.1016/s1474-4422(19)30068-7

[12] L. R. Coutinho and H. F. Rodrigues, “Epidemiological analysis of the factors of risk of cerebrovascular accident by use of a risk estimator software in the primary attention,”, Physiotherapy in Health Care 3, https://www.semanticscholar.org/paper/AN%C3%81LISE-EPIDEMIOL%C3%93GICA-DOS-FATORES-DE-RISCO-DE￾PELO-Coutinho-Rodrigues/b1d88d288dd287739041cab9be6cdf01d2ba88d0 (accessed Aug. 6, 2023

[13] Z. Bursac, C. H. Gauss, D. K. Williams, and D. W. Hosmer, “Purposeful selection of variables in logistic regression - source code for Biology and Medicine,” BioMed Central, https://scfbm.biomedcentral.com/articles/10.1186/1751-0473-3-17?report=reader (accessed Jun. 29, 2023).

[14] J. Chambers, “Software for Data Analysis,” Statistics and Computing, 2008. doi:10.1007/978-0-387-75936-4 

[15] J. R. Quinlan, “Induction of decision trees - machine learning,” SpringerLink, https://link.springer.com/article/10.1007/BF00116251 (accessed Jun. 29, 2023).

[16] M. O. Owolabi et al., “Global synergistic actions to improve brain health for human development,” Nature News, https://www.nature.com/articles/s41582-023-00808-z (accessed Aug. 7, 2023).

[17] A. Scutelnic, M. R. Heldner, S. Jung, and M. Arnold, “The role of physical activity in primary stroke prevention,” Swiss Sports; Exercise Medicine, vol. 67, no. 4, Jan. 2020. doi:10.34045/ssem/2019/34

[18] R. Soto-Cámara et al., “Age-related risk factors at the first stroke event,” Journal of Clinical Medicine, vol. 9, no. 7, p. 2233, Jul. 2020. doi:10.3390/jcm9072233

[19] K. Kadier et al., “Association of sleep-related disorders with cardiovascular disease among adults in the United States: A cross￾sectional study based on National Health and Nutrition Examination Survey 2005–2008,” Frontiers in Cardiovascular Medicine, vol. 9, Aug. 2022. doi:10.3389/fcvm.2022.954238

[20] B.-H. Chao et al., “Stroke prevention and control system in China: CSPPC-stroke program,” International Journal of Stroke, vol. 16, no. 3, pp. 265–272, Mar. 2020. doi:10.1177/1747493020913557

[21] V. Kumar, K. Bishayee, S. Park, U. Lee, and J. Kim, “Oxidative stress in cerebrovascular disease and associated diseases,” Frontiers in Endocrinology, vol. 14, Feb. 2023. doi:10.3389/fendo.2023.1124419

[22] M. Amponsah-Offeh, P. Diaba-Nuhoho, S. Speier, and H. Morawietz, “Oxidative stress, antioxidants and hypertension,” Antioxidants, vol. 12, no. 2, p. 281, Jan. 2023. doi:10.3390/antiox12020281

[23] V. L. Feigin et al., “Global, regional, and national burden of stroke and its risk factors, 1990-2019: A systematic analysis for the global burden of disease study 2019,” The Lancet. Neurology, https://pubmed.ncbi.nlm.nih.gov/34487721/ (accessed Aug. 7, 2023).

[24] A. J. S. Webb and D. J. Werring, “New insights into cerebrovascular pathophysiology and hypertension,” Stroke, vol. 53, no. 4, pp. 1054–1064, Apr. 2022. doi:10.1161/strokeaha.121.035850

[25] L. Lauder et al., “Hypertension management in patients with cardiovascular comorbidities,” European Heart Journal, vol. 44, no. 23, pp. 2066–2077, Nov. 2022. doi:10.1093/eurheartj/ehac395

[26] O. Mosenzon, A. Y. Cheng, A. A. Rabinstein, and S. Sacco, “Diabetes and stroke: What are the connections?,” Journal of Stroke, vol. 25, no. 1, pp. 26–38, Jan. 2023. doi:10.5853/jos.2022.02306

[27] R. Chen, B. Ovbiagele, and W. Feng, “Diabetes and stroke: Epidemiology, pathophysiology, pharmaceuticals and outcomes,” The American Journal of the Medical Sciences, vol. 351, no. 4, pp. 380–386, Apr. 2016. doi:10.1016/j.amjms.2016.01.011

[28] F. Z. Caprio and F. A. Sorond, “Cerebrovascular disease,” Medical Clinics of North America, vol. 103, no. 2, pp. 295–308, Mar. 2019. doi:10.1016/j.mcna.2018.10.001

[29] J. Klein, P. Diaba-Nuhoho, S. Giebe, C. Brunssen, and H. Morawietz, “Regulation of endothelial function by cigarette smoke and next-generation tobacco and nicotine products,” Pflügers Archiv - European Journal of Physiology, vol. 475, no. 7, pp. 835–844, Jun. 2023. doi:10.1007/s00424-023-02824-w

[30] C. W. Tsao and et al., “Correction to: Heart disease and stroke Statistics—2023 update: A report from the American Heart Association,” Circulation, vol. 147, no. 8, Feb. 2023. doi:10.1161/cir.0000000000001137

[31] N. E. Andrew et al., “The population effect of a national policy to incentivize chronic disease management in primary care instroke: A population-based cohort study using an emulated target trial approach,” The Lancet Regional Health - Western Pacific, vol. 34, p. 100723, May 2023. doi:10.1016/j.lanwpc.2023.100723

[32] E. Douven et al., “Co-occurrence of depressive symptoms and executive dysfunction after stroke: associations with brain pathology and prognosis,” Journal of Neurology, Neurosurgery & Psychiatry, https://jnnp.bmj.com/content/89/8/859.info (accessed Aug. 7, 2023).

[33] E. Maalouf, S. Hallit, P. Salameh, and H. Hosseini, “Depression, anxiety, insomnia, stress, and the way of coping emotions asrisk factors for ischemic stroke and their influence on stroke severity: A case–control study in Lebanon,” Frontiers, https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1097873/full (accessed Jul. 4, 2023).

[34] M. Deng, S. Zhai, X. Ouyang, Z. Liu, and B. Ross, “Factors influencing medication adherence among patients with severe mental disorders from the perspective of mental health professionals,” BMC Psychiatry, vol. 22, no. 1, Jan. 2022. doi:10.1186/s12888-021-03681-6

[35] H. Koo et al., “Risk of cardiovascular events according to the tricyclic antidepressant dosage in patients with chronic pain: A retrospective cohort study,” European Journal of Clinical Pharmacology, vol. 79, no. 1, pp. 159–171, Nov. 2022. doi:10.1007/s00228-022-03421-z

[36] C. Krittanawong et al., “Association of Depression and Cardiovascular Disease,” The American Journal of Medicine, vol. 136, no. 9, pp. 881–895, Sep. 2023. doi:10.1016/j.amjmed.2023.04.036

[37] B. Sabayan et al., “The role of population-level preventive care for Brain Health in ageing,” The Lancet Healthy Longevity, vol. 4, no. 6, Jun. 2023. doi:10.1016/s2666-7568(23)00051-x

[38] K. Kadier et al., “Association of sleep-related disorders with cardiovascular disease among adults in the United States: A crosssectional study based on National Health and Nutrition Examination Survey 2005–2008,” Frontiers in Cardiovascular Medicine, vol. 9, Aug. 2022. doi:10.3389/fcvm.2022.954238

[39] M. K. Fleming et al., “Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia,” Journal of Sleep Research, Jul. 2023. doi:10.1111/jsr.13971

[40] S. Garbarino, P. Lanteri, N. L. Bragazzi, N. Magnavita, and E. Scoditti, “Role of sleep deprivation in immune-related disease risk and outcomes,” Communications Biology, vol. 4, no. 1, Nov. 2021. doi:10.1038/s42003-021-02825-4

[41] L. Korostovtseva, “Ischemic stroke and sleep: The linking genetic factors,” Cardiology and Therapy, vol. 10, no. 2, pp. 349–375, Jun. 2021. doi:10.1007/s40119-021-00231-9

[42] H. Wang, J. Sun, M. Sun, N. Liu, and M. Wang, “Relationship of sleep duration with the risk of stroke incidence and stroke mortality: An updated systematic review and dose–response meta-analysis of prospective cohort studies,” Sleep Medicine, vol. 90, pp. 267–278, Feb. 2022. doi:10.1016/j.sleep.2021.11.001

[43] C. Sarmiento and C. Lau, “Diagnostic and statistical manual of mental disorders, 5th ed.: DSM‐5,” The Wiley Encyclopedia of Personality and Individual Differences, pp. 125–129, Sep. 2020. doi:10.1002/9781119547174.ch198 

[44] F. Routledge and J. McFetridge-Durdle, “Nondipping blood pressure patterns among individuals with essential hypertension: A review of the literature,” European Journal of Cardiovascular Nursing, vol. 6, no. 1, pp. 9–26, Mar. 2007. doi:10.1016/j.ejcnurse.2006.05.001

[45] M. Sieminski and M. Partinen, “‘non-dipping’ is equally frequent in narcoleptic patients and in patients with insomnia,” Sleep and Biological Rhythms, vol. 14, no. 1, pp. 31–36, Nov. 2015. doi:10.1007/s41105-015-0004-z

[46] B. Mete and L. Keskin, “Effects of sleep quality and insomnia severity on metabolic and anthropometric parameters in elderly individuals,” Cukurova Medical Journal, vol. 48, no. 3, pp. 806–814, Sep.2023. doi:10.17826/cumj.1309925

[47] J. Belloir, N. Makarem, and A. Shechter, “Sleep and circadian disturbance in cardiovascular risk,” Current Cardiology Reports, vol. 24, no. 12, pp. 2097–2107, Nov. 2022. doi:10.1007/s11886-022-01816-z

[48] P. K. Kamat et al., “The Time Dimension to stroke: Circadian effects on stroke outcomes and Mechanisms,” Neurochemistry International, vol. 162, p. 105457, Jan. 2023.doi:10.1016/j.neuint.2022.105457

[49] L. J. Daniels, D. Kay, T. Marjot, L. Hodson, and D. W. Ray, “Circadian regulation of liver metabolism: Experimental approaches in human, rodent, and cellular models,” American Journal of Physiology-Cell Physiology, vol. 325, no. 5, Nov. 2023. doi:10.1152/ajpcell.00551.2022

[50] N. Schurhoff and M. Toborek, “Circadian rhythms in the blood–brain barrier: Impact on neurological disorders and stress responses,” Molecular Brain, vol. 16, no. 1, Jan. 2023. doi:10.1186/s13041-023-00997-0

[51] E. Reshetnyak et al., “Impact of multiple social determinants of health on incident stroke,” Stroke, vol. 51, no. 8, pp. 2445–2453, Aug. 2020. doi:10.1161/strokeaha.120.028530

[52] R. V. Krishnamurthi, V. L. Feigin, and T. Ikeda, “Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016,” New England Journal of Medicine, vol. 379, no. 25, pp. 2429–2437, Mar. 2018. doi:10.1056/nejmoa1804492

[53] D. A. Levine, P. W. Duncan, M. N. Nguyen-Huynh, and O. G. Ogedegbe, “Interventions targeting racial/ethnic disparities in stroke prevention and treatment,” Stroke, vol. 51, no. 11, pp. 3425–3432, Nov. 2020. doi:10.1161/strokeaha.120.030427

[54] S. S. Virani et al., “Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association,” Circulation, vol. 141, no. 2, pp. e139–e596, Jan. 2020. doi:10.1161/cir.0000000000000746

[55] W. C. Willett and M. J. Stampfer, “Rebuilding the food pyramid,” Scientific American, vol. 288, no. 1, pp. 64–71, Jan. 2003. doi:10.1038/scientificamerican0103-64

[56] J. Spence, “Nutrition and risk of stroke,” Nutrients, vol. 11, no. 3, p. 647, Mar. 2019. doi:10.3390/nu11030647

[57] J. S. Chhabra et al., “The effect of nutrition on stroke risk: A systematic review,” Nutrition and Health, vol. 29, no. 2, pp. 255–267, Aug. 2022. doi:10.1177/02601060221122218

[58] M. Ryu, “Registry studies of stroke in Japan,” Journal of Atherosclerosis and Thrombosis, 2023. doi:10.5551/jat.rv22008

[59] R. C. Das et al., “Heart disease detection using ML,” 2023 IEEE 13th Annual Computing and Communication Workshop and Conference (CCWC), Mar. 2023. doi:10.1109/ccwc57344.2023.10099294

[60] Y. Yang, J. Zheng, Z. Du, Y. Li, and Y. Cai, “Accurate prediction of stroke for hypertensive patients based on medical big data and Machine Learning Algorithms: Retrospective study,” JMIR Medical Informatics, vol. 9, no. 11, Nov. 2021. doi:10.2196/30277

[61] Owolabi MO;Thrift AG;Mahal A;Ishida M;Martins S;Johnson WD;Pandian J;Abd-Allah F;Yaria J;Phan HT;Roth G;Gall SL;Beare R;Phan TG;Mikulik R;Akinyemi RO;Norrving B;Brainin M;Feigin VL; ;, “Primary stroke prevention worldwide: Translating evidence into action,” The Lancet. Public health, https://pubmed.ncbi.nlm.nih.gov/34756176/ (accessed Aug. 9, 2023).

[62] V. L. Feigin et al., “Digital Solutions for primary stroke and cardiovascular disease prevention: A mass individual and public health approach,” The Lancet Regional Health - Western Pacific, vol. 29, p. 100511, Dec. 2022. doi:10.1016/j.lanwpc.2022.100511

[63] E. Wong et al., “The Singapore National Precision Medicine Strategy,”Nature News, https://www.nature.com/articles/s41588-022-01274-x (accessed Aug. 7, 2023).

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