Prevalence of stroke symptoms among stroke-free residents: first national data from Lebanon

Background Stroke symptoms are common among people without a history of stroke or transient ischemic attack. Reported stroke symptoms may represent stroke episodes that failed to reach the threshold for clinical diagnosis. Aims This study aimed to assess in the Lebanese population the prevalence of self-reported stroke symptoms in a stroke-and transient ischemic attack-free population, and the association of these symptoms with major risk factors for stroke. Methods We carried out a cross-sectional study using a multistage cluster sample across Lebanon. We interviewed residents aged 40 years and more. Stroke symptoms were assessed using the Questionnaire for Verifying Stroke-Free Status. Results We included 1515 individuals (mean age was 57.2 ± 12.4 years, 783 women, 51.7%). Among 1460 participants stroke- and transient ischemic attack-free, 175 had experienced at least one stroke symptom (12.1%, 95% CI 9.9%-14.3%). Arterial hypertension (adjOR 4.37, 95% CI 2.68-7.12), history of heart disease (adjOR 3.34, 95% CI 2.00-5.56), current waterpipe smoking (adjOR 3.88, 95% CI 2.33-6.48), current and former cigarette smoking (adjOR 1.84, 95% CI 1.18-2.87 and adjOR 2.01, 95% CI 1.13-3.5, respectively), psychological distress (adjOR 1.04, 95% CI 1.02-1.05), the Mediterranean diet score (adjOR 0.87, 95% CI 0.76-0.99), and regular physical activity (adjOR 0.45, 95% CI 0.26-0.77) were independently associated with stroke symptoms. Conclusions This is the first study conducted in the Middle East, assessing self-reported stroke symptoms among stroke-free residents. Our study showed that almost one in eight residents without a history of stroke or transient ischemic attack has had stroke symptoms. Major vascular risk factors are associated with these symptoms, thus allowing for prevention strategies.