Hemorrhagic stroke in Saudi adult male population and the ABO blood group distribution: a comparative analysis

Mohammad P. Farshori, Yasir G. Alrashdan, Mohammed S. Alshammari


Background: Globally stroke is leading cause of death and disability. According to WHO every year 15 million people get stroke and one third of these subjects die and about 5 million become permanently disabled. In SA smoking, diabetes, and hypertension are highly prevalent and since these factors are among ten major risk factors for stroke it puts Saudi population at higher risk of stroke. In current study we studied prevalence of hemorrhagic (HS) stroke and analyzed if there is any correlation between incidences of HS and ABO blood groups in Saudi population.

Methods: Blood groups and other relevant data were collected for 2304 stroke patients registered at King Khaled hospital between 1/1/2008 to 1/6/2018. Statistical analysis was performed using Z calculator.

Results: We saw 5.4-fold increase in prevalence of diabetes type 2 and 8.7 fold increase in prevalence of hypertension among HS patients as compared to control subjects. Prevalence of smoking was higher in both control and HS patients. 21.7% of stroke patients were HS patients. Distribution of A blood group was significantly higher in male HS patients. AB blood group showed statistically significant reduction in HS patients as compared to control group. Results were statistically significant at (p˂0.01). However, blood group B and O showed no significant differences between two groups.

Conclusions: Results of our studies show a correlation between ABO and the incidences of hemorrhagic stroke in Saudi adult male population. Larger studies are needed to confirm these results.


ABO and Rh blood groups, Cardiovascular disease, Diabetes, Hypertension, Hemorrhagic stroke, Obesity

Full Text:



Caplan LR. Caplan’s stroke: A clinical approach. 3rd edition. Phidalphia: Saunders; 2009:2000.

Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009;8(4):345-54.

O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-75.

Farshori MP, Yasir GI, Abdulmajeed HM, Raiya Khaled AT, Hayam AHA, Abrar Hamad SA, et al. Frequency of expression and the distribution of ABO and Rh, blood group antigens in the myocardial infarction (MI) male patients of the Hail region in Saudi Arabia. J Integrative Cardiol. 2017;3(4):1-5.

Farshori MP, Alrashdan YG, AlTamimi RK, Alshammari HA, Alshammari MS, Alageel AH, et al. High prevalence of hypertension and myocardial infarctions in Saudi adult female population with blood type A. Inter J Commu Med Public Health. 2018;5(11):4676-83.

El Bcheraoui C, Memish ZA, Tuffaha M, Daoud F, Robinson M, Jaber S, et al. Hypertension and its associated risk factors in the Kingdom of Saudi Arabia, 2013: a national survey. Inter J Hypertension. 2014;2014:1-8.

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89.

Farshori MP, Al-Wakid IH, Ibrahim IK, ALShammari AF, Alduejieman M, Almhanaa AM, et al. Distribution of ABO and Rhesus (Rh) blood group antigens in male type 2 diabetes mellitus patients in Hail region of Saudi Arabia: High incidences of diabetes mellitus in males with B+ blood type. Integr Obesity Diabetes. 2016;2:233-8.

Farshori M, Al-Muzaini AY, Al-Wakid IH, Ibrahim IK, ALShammari AF, Alduejieman M, et al. Frequency of distribution of abo and rhesus (Rh) blood group antigens in the female type 2 diabetes mellitus (T2DM) patients in hail region of Saudi Arabia. Integrative Obes Diab. 2017;3(1):1-6.

Garg P, Kumar J, Choudhary R, Chawla VK. Association between ABO Blood Groups and Myocardial Infarction in Jodhpur City of India. J Bangladesh Soc Physiol. 2012;7(1):13-7.

He M, Wolpin B, Rexrode K, Manson JAE. ABO blood group and risk of coronary heart disease in two prospective cohort studies. Arterioscler, Thromb, Vascular Biol. 2012;32:2314-20.

Hu X, Qiao S, Qiu H, Ye S, Feng L, Song L. Association between ABO blood group and acute myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi. 2015;3(9):785-7.

Chandra KR,Jyotsna S. Relation of ABO blood group and hypertension in medical students of Kathmandu medical college, Duwakot Bhaktapur. Inter J Sci Res. 2017;6(11)177-80.

Hercegovac A, Hajdarevic E, Hodzic S, Halilovic E, Avdic A, Habibovic M. Blood group, hypertension, and obesity in the student population of northeast bosnia and harzegovina. A. Badnjevic (Ed), CMBEBIH 2017 IFMBE Proceedings. 2017;62:774-7.

Carpeggiani C, Coceani M, Landi P, Michelassi C, L’abbate A. ABO blood group alleles: A risk factor for coronary artery disease. An angiographic study. Atheroscler. 2010;211(2):461-6.

Sadiq H, Anjum R, Shaikh SM, Mushtaq S, Negi M, Kasana P. A study on the correlation of ABO blood group system and hypertension. Inter J Applied Dent Sci. 2017;3(4):38-41.

Biswas S, Ghoshal PK, Halder B, and Mandal N. Distribution of ABO blood group and major cardiovascular risk factors with coronary heart disease. Biomed Res Int. 2013;2013.

Gong P, Li S, Hu L, Luo S, Li J, Jiang H. Total cholesterol mediates the effect of ABO blood group on coronary heart disease. Zhonghua Xin Xue Guan Bing Za Zhi. 2015;43(5):404-7.

Maxwell RD, Maxwell KN. ABO blood groups and hypertension. Brit Med J. 1955;2(4932):179-80.

Hanson E, Karlsson S, Jood K, Nilsson S, Blomstrand C, Jern C. No evidence for an association between ABO blood group and overall ischemic stroke or any of the major etiologic subtypes. Thromb Res. 2012 Sep;130(3):339-42.

Wiggins KL, Smith NL, Glazer NL, Rosendaal FR, Heckbert SR, Psaty BM, et al. ABO genotype and risk of thrombotic events and hemorrhagic stroke. J Thromb Haemost.2009;7(2):263-9.

Zakai NA, Judd SE, Alexander K, McClure LA, Kissela BM, Howard G, et al. ABO blood type and stroke risk: The reason for geographic and racial differences in stroke study. J Thromb Haemost. 2014;12(4)564-70.

Kim DK, Bang JH, Lee J, Jun TH, Jeong YJ, Kim HJ, et al. An associaciation between ABO blood types and ischemic stroke. Korean J Fam Prac. 2014;4(4):315-20.

Gong P, Li S, Hu L, Luo S, Li J, Jiang H. Total cholesterol mediates the effect of ABO blood group on coronary heart disease. Zhonghua xin xue guan bing za zhi. 2015 May;43(5):404-7.

Liu X, Chen X, Yang J, Guo R. Association of ABO blood groups with von Willebrand factor, factor VIII and ADAMTS-13 in patients with lung cancer. Oncol Lett. 2017;14(3):3787-94.

Alb anez S, Ogiwara K, Michels A, Hopman W, Grabell J, James P, et al. Aging and ABO blood type influence von Willebrand factor and factor VIII levels through interrelated mechanisms. J Thromb Haemost. 2016;14:953-63.

Hussain M, Sharma SR, Jamil MD. A hospital based study of stroke in young from north east India. Ann Indian Acad Neurol. 2018;21(3):184-7.

World Health Organization (WHO). Diabetes country (Saudi Arabia) profiles 2016; WHO bulletin. ISBN 9789241563871.

Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. WHO Bulletin. 2016;94(9):634A.