Rita V Krishnamurthi1, Suzanne Barker-Collo1, Varsha Parag1, Priyakumari Parmar1, Emma Witt1, Amy Jones1, Susan Mahon1, Craig S Anderson1, P Alan Barber1, Valery L Feigin2. 1. From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.). 2. From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.). valery.feigin@aut.ac.nz.
Abstract
BACKGROUND AND PURPOSE: Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. METHODS: ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. RESULTS: In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. CONCLUSIONS: A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger strokes. Increased rates of large-artery atherosclerosis and small-vessel occlusion are associated with increased smoking and high blood pressure. Ethnic differences in the proportional distribution of pathological stroke subtypes suggest differential exposure and susceptibility to risk factors.
BACKGROUND AND PURPOSE: Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. METHODS: ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. RESULTS: In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. CONCLUSIONS: A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger strokes. Increased rates of large-artery atherosclerosis and small-vessel occlusion are associated with increased smoking and high blood pressure. Ethnic differences in the proportional distribution of pathological stroke subtypes suggest differential exposure and susceptibility to risk factors.
Authors: Fred S Sarfo; Bruce Ovbiagele; Onoja Akpa; Albert Akpalu; Kolawole Wahab; Reginald Obiako; Morenikeji Komolafe; Lukman Owolabi; Godwin Ogbole; Benedict Calys-Tagoe; Adekunle Fakunle; Taofeek Sanni; Gebregziabher Mulugeta; Salaam Abdul; Adeseye A Akintunde; Samuel Olowookere; Ezinne O Uvere; Philip Ibinaiye; Joshua Akinyemi; Kelechukwu Uwanuruochi; Balogun Olayemi; Olufemi A Odunlami; Esther Abunimye; Oyedunni Arulogun; Suleiman Y Isah; Sani A Abubakar; Adebayo Oladimeji; Philip Adebayo; Vincent Shidali; Innocent I Chukwuonye; Josephine Akpalu; Moyinoluwalogo M Tito-Ilori; Osahon J Asowata; Emmanuel O Sanya; Ganiyu Amusa; Ugochukwu Onyeonoro; James A Ogunmodede; Abdullateef G Sule; Cynthia Akisanya; Yaw Mensah; Olalekan I Oyinloye; Lambert Appiah; Atinuke M Agunloye; Godwin O Osaigbovo; Eunice Olabinri; Philip M Kolo; Obiora Okeke; Abiodun M Adeoye; Olabamiji Ajose; Carolyn Jenkins; Daniel T Lackland; Adedeji A Egberongbe; Olaleye Adeniji; Osimhiarherhuo Ohifemen Adeleye; Hemant K Tiwari; Donna Arnett; Ruth Y Laryea; Taiwo Olunuga; Kazeem S Akinwande; Lucius Imoh; Okechukwu S Ogah; Ezinne S Melikam; Adeyemo Adebolaji; Wisdom Oguike; Olumayowa Ogunronbi; Wasiu Adeniyi; Obiabo Y Olugbo; Abiodun H Bello; Kenneth A Ohagwu; Luqman Ogunjimi; Francis Agyekum; Henry Iheonye; Julius Adesina; Samuel Diala; Hamisu A Dambatta; Joyce Ikubor; Arti Singh; Sheila Adamu; Vida Obese; Nathaniel Adusei; Dorcas Owusu; Michael Ampofo; Raelle Tagge; Richard Efidi; Bimbo Fawale; Joseph Yaria; Rufus Akinyemi; Mayowa Owolabi Journal: Stroke Date: 2021-09-30 Impact factor: 7.914
Authors: Maciej Bladowski; Jakub Gawrys; Damian Gajecki; Ewa Szahidewicz-Krupska; Anna Sawicz-Bladowska; Adrian Doroszko Journal: Oxid Med Cell Longev Date: 2020-08-28 Impact factor: 6.543
Authors: Emilio Rodríguez-Castro; Iria López-Dequit; María Santamaría-Cadavid; Susana Arias-Rivas; Manuel Rodríguez-Yáñez; José Manuel Pumar; Pablo Hervella; Esteban López-Arias; Andrés da Silva-Candal; Ana Estany; María Piñeiro-Lamas; Tomás Sobrino; Francisco Campos; Manuel Portela; Manuel Vázquez-Lima; José Castillo; Ramón Iglesias-Rey Journal: BMC Neurol Date: 2018-10-03 Impact factor: 2.474