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| Stroke incidence remains stable despite increased prevention |
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13 March 2006
French researchers have found that the incidence of stroke in their country over the last 20 years has remained stable, despite increased treatment of stroke risk factors. "Over the past 20 years, the medical practice improved with a significant rise in antiplatelet and anticoagulant stroke-preventive therapy," said Dr Isabelle Benatru (Stroke Registry of Dijon) and co-workers. They noted an absence of decrease in global stroke incidence, and a redistribution of incidence rates among the stroke sub-types associated with vascular risk factors evolution.
Analysis of data in a population-based stroke registry established in 1985 revealed a significant increase in the use of antiplatelet drugs, rising from 5.2% in 1985 to 27% in 2004. The results, presented at the 55th American College of Cardiology Annual Scientific Sessions in Atlanta, Georgia, USA, showed that anticoagulant prescriptions increased from 2.6% to 7.7%, while hypertension treatment remained stable at about 48%. The absolute number of strokes increased over the same time period, from 875 to 972. The average age of men at first stroke increased from 66 years in 1985 to 71 years in 2004, while the age of women increased from 68 to 76 years.
The proportion of patients who smoked decreased from 38% to 25%, the prevalence of diastolic blood pressure of 90 mmHg or over decreased from 54% to 36%, and 38% of patients who had a stroke in 1985 had a history of myocardial infarction compared with 25% of patients in 2004. The proportion of patients with hypercholesterolaemia increased from 11.7% to 29% and the prevalence of diabetes increased from 10% to 18%. The prevalence of hypertension, previous transient ischaemic attacks, and atrial fibrillation remained stable, at around 65%, 24%, and 23%, respectively. Overall, the incidence of stroke remained stable, although lacunar strokes increased and strokes of cardioembolic origin became less frequent.
"This is the first study of this magnitude showing that major risk factors for stroke remain uncompletely controlled and may explain the absence of decrease of stroke incidence," the investigators concluded.
Reference:
ACC 2006
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