Epidemiology of stroke in Northern Italy: the Cerebrovascular Aosta Registry, 2004–2008

Abstract

Our aim was to prospectively ascertain the incidence of first-ever stroke and ischaemic stroke subtypes, mortality, functional outcome and recurrence in Northern Italy. We identified all possible cases of stroke (1st January 2004 and 31st December 2008). Multiple overlapping sources were used. Standard definitions for incident cases, pathological types and infarction subtypes were used. Patient characteristics were identified and analysed, case-fatality was ascertained from administrative databases, and outcome was assessed in all surviving patients by modified Rankin Scale. We identified 1,326 incident strokes. The pathological diagnosis was confirmed in 94 % of cases. The incidence of first-ever stroke was 80.2 per 100,000 (95 % CI 73–87) when adjusted to world population. The incidence of embolic stroke was significantly greater in women than in men (p < 0.001) whereas the incidence of atherothrombotic stroke was significantly greater in men than in women (p < 0.001). The case-fatality of incident strokes was 9.5 % at 7 day, 16.1 % at 28 day, and 29.9 % at 1 year. Case-fatality of ischaemic stroke was lower than that of other pathological types (p < 0.0001). Hypertension was the most important risk factor, and atrial fibrillation was the most common in embolic stroke. Increasing age, female gender and embolic stroke subtypes were associated with an adverse outcome. Data on stroke incidence and case-fatality were similar to those of other high-income countries. However, differences were found in the distribution of risk factors and prognosis across the stroke types and ischaemic stroke subtypes. Gender differences in long-term functional outcomes were significant.

The Incidence of the First-Ever Stroke in a Mediterranean Island Population: The Isle of Lesvos Stroke Study

“…These trends may indicate some future monitoring/prevention targets; nevertheless, they should be interpreted cautiously given the potential bias generated by methodological differences [6,14]. The proportional frequencies of ischemic stroke TOAST subtypes identified in the present study are within the range of estimates reported by other recent studies [7,28,30]. Future investigations in Lesvos can aim in establishing putative associations between vascular risk factor profiles with etiological stroke types/subtypes and outcome.…”

“…Comparing the present results on the prevalence of prior-to-stroke vascular risk factors to those in other recent studies, noteworthy are the higher proportions of FES patients with hypertension and/or diabetes in comparison to those in Menorca, Oxfordshire, and North Dublin [6,13,24]. In contrast, the proportional frequency of myocardial infarction appears relatively low [6,23,30,31]. Moreover, the high rates of smoking in FES patients reported in North Dublin, Warsaw (Poland) and London (UK) [6,14], were not apparent in the present study.…”

Changes in Functional Outcome Over the First Year After Stroke

“…In 2010, the number of stroke survivors was estimated to 33 million, illustrating the effect of stroke on society. [1][2][3] There are many reports on short-term survival and functional outcome after stroke, [4][5][6][7] and assessment of outcomes at 3 months is common standard in acute stroke trials. Few studies have assessed functional outcome in the longer term, and in particular, longitudinal studies with multiple assessment points are scarce.…”

Benefícios Da Hidroterapia Nos Pacientes Portadores De Sequela De Acidente Vascular Cerebral: Uma Revisão Da Literatura

“…Novak et al 24 destacam que o conhecimento médico deste agravo à saúde já data de muito tempo, pelos estudos de Framinghan e outros posteriores, com enfoque especial para os seguintes fatores determinantes ou predisponentes de arteriopatia e doença vascular: hipertensão arterial sistêmica, tabagismo, etilismo, histórico familiar, dislipidemia, diabetes mellitus, coronariopatia, sedentarismo, estresse, fibrilação atrial e estenose de carótidas 24,27 . Outro fator de risco importante é a faixa etária, a idade avançada acarreta uma redução da capacidade do cérebro para se adaptar ao estresse e está associada à um aumento marcante na incidência de doenças neurodegenerativas e AVC [28][29][30] .…”

“…Pode acontecer dentro do cérebro (hemorragia intracerebral) ou para o lado de fora, entre o cérebro e a aracnóide, ocasionando a hemorragia subacnóidea (HSA) 30 , em geral, decorrente da ruptura de aneurismas saculares congênitos localizados nas artérias do polígono de Willis 13 . Ambos AVCs hemorrágicos podem ocorrer por crise hipertensiva ou por uma alteração sanguínea em que ocorra muita dificuldade de realizar a coagulação normal (hemofilia, diminuição de plaquetas, algumas doenças reumáticas, dentre outras) 33 .…”