Stroke Incidence and Mortality Trends in US Communities, 1987 to 2011

Koton, Silvia; Schneider, Andrea L.C.; Rosamond, Wayne D.; Shahar, Eyal; Sang, Yingying; Gottesman, Rebecca F.; Coresh, Josef

doi:10.1001/jama.2014.7692

Cited by 425 publications

(238 citation statements)

References 28 publications

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“…12 In the ARIC (Atherosclerosis Risk in Communities) cohort, no decline in stroke incidence was found from 1987 to 2011 in the age group 45 to 64 years in contrast to a significant decreasing incidence above 65 years. 14 We found no significant change in incidence over time among participants aged 75 to 84 and ≥85 years, which was Figure 1. Age-adjusted time trends in incidence rates of ischemic stroke in women stratified by age (note that axis scales differ by age group).…”

Section: Discussionmentioning

confidence: 68%

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Time Trends in Incidence and Case Fatality of Ischemic Stroke

Vangen-Lønne

Wilsgaard

Johnsen

et al. 2015

Stroke

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Background and Purpose-Ischemic stroke incidence has declined in industrialized countries the last decades, with possible exception for the youngest age groups. We estimated age-and sex-specific trends in incidence and case fatality of firstever ischemic stroke between 1977 and 2010 in a Norwegian municipality. Methods-Age-adjusted time trends in incidence from 1977 to 2010 were estimated by fractional polynomial and Poisson regression, and case fatality by logistic regression in 36 575 participants of the population-based Tromsø Study. Results-There were 1214 first-ever ischemic strokes within a total follow-up time of 611 176 person-years. The overall age-and sex-adjusted incidence decreased by 24% in 1995 to 2010. In women aged 30 to 49 years, the incidence increased significantly from 1980 to 2010. In men aged 30 to 49 years, there was a nonsignificant, rising trend from 1977 to 2010. Men aged 50 to 64 years had similar incidence in 2010 compared with 1989. From the mid-1990s to 2010, the incidence declined significantly in women aged 50 to 74 years and in men aged 65 to 74 years, but remained stable in those aged ≥75 years. Case fatality decreased significantly in men aged 30 to 84 years from 1995 to 2010, whereas there was no significant change in women. Conclusions-Age-adjusted incidence of first-ever ischemic stroke increased in young women, declined in women aged 50 to 74 years and men aged 65 to 74 years and remained stable among the oldest. Case fatality declined in men aged 30 to 84 years, but not in women.

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Section: Discussionmentioning

confidence: 68%

“…3,12,14 The decrease is explained by the combined effect of reduction in risk factor levels and improved primary prevention. 3,15,16 The rising trend among men aged 50 to 64 years from 1989 to early 2000, followed by a decline until 2010, is difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

Time Trends in Incidence and Case Fatality of Ischemic Stroke

Vangen-Lønne

Wilsgaard

Johnsen

et al. 2015

Stroke

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“…The ARIC study was also restricted to participants aged 45 to 64 years at study baseline. Additionally, several studies suggest that the national incidence of CVD events has changed since the 1980s, with the incidence of CHD and stroke declining and the incidence of HF increasing,1, 50, 51 which may over‐ or underestimate the number of events reduced by population‐wide and targeted blood pressure interventions. Secondly, we assumed the same incidence rate reduction when calculating the number of events that could be prevented from interventions that targeted unaware, untreated, and uncontrolled blood pressure above goal.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

161

130

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Background US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.Methods and ResultsWe used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population‐wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987–1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of “428.” A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100 000 person‐years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person‐years, respectively, in whites. In contrast, a 1 mm Hg population‐wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person‐years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population‐wide and targeted interventions.ConclusionsModest population‐wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

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“…This decline in mortality is welcome and stems from implementation of stroke guidelines and improved care in the acute setting. Recent epidemiological studies indicate a decline in stroke incidence 16. However, even with this decline in stroke incidence, mortality is declining faster than the reduction in incidence 16.…”

Section: Stroke Is Not a Killer But A Chronic And Progressive Disablimentioning

confidence: 99%

Emergent properties of neural repair: elemental biology to therapeutic concepts

Carmichael

2016

Annals of Neurology

118

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Stroke is the leading cause of adult disability. The past decade has seen advances in basic science research of neural repair in stroke. The brain forms new connections after stroke, which have a causal role in recovery of function. Brain progenitors, including neuronal and glial progenitors, respond to stroke and initiate a partial formation of new neurons and glial cells. The molecular systems that underlie axonal sprouting, neurogenesis, and gliogenesis after stroke have recently been identified. Importantly, tractable drug targets exist within these molecular systems that might stimulate tissue repair. These basic science advances have taken the field to its first scientific milestone; the elemental principles of neural repair in stroke have been identified. The next stages in this field involve understanding how these elemental principles of recovery interact in the dynamic cellular systems of the repairing brain. Emergent principles arise out of the interaction of the fundamental or elemental principles in a system. In neural repair, the elemental principles of brain reorganization after stroke interact to generate higher order and distinct concepts of regenerative brain niches in cellular repair, neuronal networks in synaptic plasticity, and the distinction of molecular systems of neuroregeneration. Many of these emergent principles directly guide the development of new therapies, such as the necessity for spatial and temporal control in neural repair therapy delivery and the overlap of cancer and neural repair mechanisms. This review discusses the emergent principles of neural repair in stroke as they relate to scientific and therapeutic concepts in this field. Ann Neurol 2016;79:895–906

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Stroke Incidence and Mortality Trends in US Communities, 1987 to 2011

Abstract: In a multicenter cohort of black and white adults in US communities, stroke incidence and mortality rates decreased from 1987 to 2011. The decreases varied across age groups, but were similar across sex and race, showing that improvements in stroke incidence and outcome continued to 2011.

Cited by 425 publications

References 28 publications

Time Trends in Incidence and Case Fatality of Ischemic Stroke

Time Trends in Incidence and Case Fatality of Ischemic Stroke

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Emergent properties of neural repair: elemental biology to therapeutic concepts

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