Since 1985 there has been a Stroke Registry in Dijon to record every stroke occurring in the population of a city of 140,000 inhabitants. The survey has been exhaustive and included the numerous sources of information as well as CT scanning. The annual incidence is 145/100,000 with an annual specific incidence of 170/100,000 in men, 126/100,000 in women. The annual specific incidence shows a female preponderance until 30 years of age, after which the males lead from the age of 30 to 80, when the rates become equal. Sixty-eight percent of strokes produced by infarct, 12% by lacunae, 5% by subarachnoid hemorrhage and 15% by cerebral hemorrhage. Differences exist in this distribution, with the preponderance of young people in subarachnoid hemorrhage, and cerebral hemorrhage is commoner in the 5th decade while infarct increases with age in both sexes. Infarct appears commoner during winter, transient ischemic attacks during summer, while cerebral hemorrhage has a constant incidence during the year. Mortality is high mainly during the 1st month with 12.5% during the 1st week, 21.5% the 1st month and 30% the 1st year. Our results are in the mean similar to white occidental countries, but opposite to those observed in Japan; they emphasize the importance of the lacunar syndrome, and the seasonal variations in different types of stroke.
Background and Purpose— The TST trial (Treat Stroke to Target) evaluated the benefit of targeting a LDL (low-density lipoprotein) cholesterol of <70 mg/dL to reduce the risk of cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature or aortic arch plaque >4 mm, in a French and Korean population. The follow-up lasted a median of 5.3 years in French patients (similar to the median follow-up time in the SPARCL trial [Stroke Prevention by Aggressive Reduction in Cholesterol Level]) and 2.0 years in Korean patients. Exposure duration to statin is a well-known driver for cardiovascular risk reduction. We report here the TST results in the French cohort. Methods— One thousand seventy-three French patients were assigned to <70 mg/dL (1.8 mmol/L) and 1075 to 100±10 mg/dL (90–110 mg/dL, 2.3–2.8 mmol/L). To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe on top if needed. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization and vascular death. Results— After a median follow-up of 5.3 years, the achieved LDL cholesterol was 66 (1.69 mmol/L) and 96 mg/dL (2.46 mmol/L) on average, respectively. The primary end point occurred in 9.6% and 12.9% of patients, respectively (HR, 0.74 [95% CI, 0.57–0.94]; P =0.019). Cerebral infarction or urgent carotid revascularization following transient ischemic attack was reduced by 27% ( P =0.046). Cerebral infarction or intracranial hemorrhage was reduced by 28% ( P =0.023). The primary outcome or intracranial hemorrhage was reduced by 25% ( P =0.021). Intracranial hemorrhages occurred in 13 and 11 patients, respectively (HR, 1.17 [95% CI, 0.53–2.62]; P =0.70). Conclusions— After an ischemic stroke of documented atherosclerotic origin, targeting a LDL cholesterol of <70 mg/dL during 5.3 years avoided 1 subsequent major vascular event in 4 (number needed to treat of 30) and no increase in intracranial hemorrhage. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875.
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