Background and Purpose-Several studies indicate a declining case-fatality and mortality in stroke. Little is known about time trends in stroke for subjects with diabetes. The purpose of this study was to compare time trends in incidence, case-fatality and mortality for stroke patients with or without diabetes. Methods-This study was based on the Northern Sweden MONICA Project Stroke registry during 1985 to 2003. 15 382 patients, aged 35 to 74 years, were included in the study. 11 605 had a first-ever stroke and 3777 had a recurrent stroke.In both men and women previously diagnosed diabetes was found in 22.8%. Results-The incidence of stroke was 5 and 8 times higher in diabetic subjects than in nondiabetics, in men and women, respectively. Incidence of first-ever stroke decreased for nondiabetic men, probability value Ͻ0.001, and for diabetic women, probability valueϭ0.012. Recurrent stroke incidence declined highly significant, probability value Ͻ0.001, in all but diabetic men. For diabetic women, the decrease in incidence in first and recurrent stroke was significantly greater than in nondiabetic women. Case-fatality and mortality in stroke declined for all groups except diabetic women with first-ever stroke. The time trends in case fatality and mortality did not differ significantly between nondiabetic and diabetic patients. Conclusion-The incidence of stroke declined in both nondiabetic and diabetic subjects except for diabetic men and for nondiabetic women with first-ever stroke. Case-fatality in first-ever stroke declined for all but diabetic women. This led to a decreased mortality over the 19-year period for both groups. This is the first time that the decline in stroke incidence is reported in this MONICA population. (Stroke. 2008;39:3137-3144.)

No abstract

Abstract. Lundblad D, Dinesen B, Rautio A, Røder ME, Eliasson M (Sunderby Hospital, Luleå; University of Umeå, Umeå, Sweden; Steno Diabetes Center, Gentofte; and University of Copenhagen, Copenhagen NV, Denmark). Low level of tissue plasminogen activator activity in non-diabetic patients with a first myocardial infarction. J Intern Med 2005; 258: 13-20.Objective. To explore the role of tissue plasminogen activator (tPA) activity and plasminogen activator inhibitor type 1 (PAI-1) in survivors of a first myocardial infarction (MI). Insulin and proinsulin were analysed as potential risk factors. Design. Case-control study in northern Sweden. Subjects. A total of 115 patients under 65 years of age with a first MI were enrolled and recalled for further examination 3 months later. Twenty-seven patients were excluded, 17 with known diabetes and 10 who did not come to the follow-up, giving a final number of 88 patients, 73 men and 15 women. Patients were age-and sex matched with control subjects drawn from the local cohort in the MONICA population survey 1994.Main outcome measures. We compared MI patients and controls using univariate and multiple regression analyses including odds ratios (OR).Results. PAI-1 activity, fibrinogen, postload insulin and -proinsulin were significantly higher and tPA activity significantly lower in MI patients in the univariate analysis. In a multiple regression analysis, including also age, sex and cardiovascular risk factors, these parameters were divided in quartiles. The lowest quartile of tPA activity was significantly associated with MI (OR ¼ 19.1; CI 3.0-123) together with the highest quartiles of fibrinogen (OR ¼ 25; CI 5.2-120) but other variables were not. Conclusion. Low tPA activity, i.e. low fibrinolytic activity, characterized nondiabetic subjects after a first MI which is not explained by concomitant disturbances in metabolic and anthropometric variables.