Abstract 2183: Evolution in Stroke Risk Factors and Medications Over 20-Year Population Based Registry
BACKGROUND : We ascertained changes in risk factors, the use of primary preventive treatments and their impact on incidence, and handicap severity at 1 month (Rankin score) of first-ever stroke from a continuous 20-year well-defined population-based registry.
METHODs: From 1st January 1985 to 31st December 2004, 1 920 ischaemic strokes from large artery atheroma, 725 from small perforating artery atheroma, 497 cardio-embolism, 341 primary cerebral hemorrhage, 74 subarachnoïd hemorrhage and 134 undetermined ischaemic strokes were included in the registry.
RESULTS :The mean age significantly increased from 1985 to 2004 (66.0 vs 71.1 in men, p = 0.009 ; 67.8 vs 75.6 in women, p = 0.002) as well as the absolute number of stroke (875 to 972). Hypercholesterolemia and diabetes increased (11.7 % vs 28.7 %, p < 0.0001 and 10.4 % vs 17.5 %, p < 0.0001 respectively). In contrast, smoking, DBP ≥ 90 mmHg and previous myocardial infarction decreased (37.8 % vs 25.2 %, p < 0.0001 ; 53.7 % vs 36.4 %, p < 0.001 ; 22.2 % vs 17.9 %, p = 0.015 respectively). In contrast, hypertension (65.3 % vs 64.1 %, p = 0.57), previous transient ischemic attacks (25.2 % vs 22.3 %, p = 0.12) and previous atrial fibrillation (22.9 % vs 23.1 %, p = 0.91) remained stable. Anti-platelet and anticoagulant therapy increased (5.2 % to 27.2 %, p < 0.0001; 2.6 % to 7.7 %, p < 0.0001 respectively) whereas hypertension treatment remained stable (47.9 % vs 49.0 %, p = 0.62). Age- and sex-adjusted incidences of first-ever stroke were stable over time except for lacunar strokes whose incidence increased (p = 0.005), whereas cardioembolic incidence decreased (p = 0.002). Minor handicap significantly increased (p = 0.003); and thus was associated with a significant fall in severe handicap (p = 0.001).
CONCLUSION: Over the past 20 years, medical practice has improved with a significant rise in antiplatelet and anticoagulant stroke-preventive therapy. However, we noted an absence of a decrease in global stroke incidence, and a redistribution of incidence rates among the stroke sub-types associated with changes in vascular risk factors. This is the first study of this magnitude showing that major risk factors for stroke remain incompletely controlled, which may explain the absence of any decrease in stroke incidence.