ESOC Session Highlight- Epidemiology
Dr Erik Prestgaard (Norway), reports from the epidemiology session showed that there is a decreasing incidence of stroke worldwide, particularly in the elderly. In the young, stroke rates remain unchanged. Young stroke patients more often have embolic stroke of unknown source and have a high prevalence of cardiovascular risk factors. In data from Spain, health care cost post stroke do not only increase due to the initial hospitalization, but remain high 3 years post-stroke. The session chaired by Ale Algra and Michael Hill on Epiemiology at ESOC had 9 speakers.
Wafa and colleagues presented results from the South London Stroke Register showing a 43% decrease in the incidence ischemic stroke in the period between 2000 and 2015, despite increasing prevalence of hypertension and atrial fibrillation. Cholesterol-lowering drugs increased four-fold during the period. Decline in stroke incidence was not observed for black ethnic groups.
In Catalonia, Ribera and colleagues report that post-stroke health care costs increase primarily due to the initial hospitalization, but remained higher than prior-stroke during the all three years after the event.
Aked et al reported that first stroke incidence in southern Sweden decreased with 33 since 2000. Decrease is driven by declining ischemic stroke in the elderly. Ischemic stroke rates among the young and overall rates of intracerebral and subarachnoid hemorrhage have remained unchanged.
Muruet and colleagues studied characteristics of stroke subtype in an inner London area between 2000 and 2016. They found that patients with embolic stroke of unknown source (ESUS) were younger, more commonly male, had similar functional outcomes to their subtypes, and had lower mortality than large artery atherothrombotic (LAA) and cardioembolic (CE) stroke types.
In prospective study of almost 5000 Japanese participants, Kokubo et a found that incident carotid plaque was positively associated with total, LDL and non-HDL cholesterol, and inversely associated with HDL cholesterol.
Global data show high mortality rates and high prevalence in cardiovascular risk factors in young people who had a stroke, according to a study by Ekker and colleagues. There was, however, considerable geographical variability.
In a cohort of over 2000 healthy Norwegian men followed for 35 years, high exercise blood pressure was associated with incident stroke, independently of potential confounders including resting blood pressure and fitness level. This represents a way to unmask hypertension to better predict stroke risk, according to Prestgaard and colleagues.
According to Ganesh et al from the University of Oxford, stroke patients with pre-morbid disability have greater mortality and institutionalization if they accumulate additional disability due to the stroke. The authors argue that patients with pre-stroke disability should be included trials and that the disability should not in itself disqualify them for acute interventions.
Schellen et al aimed to assess temporal trends in intracerebral hemorrhage (ICH) between 2008 and 2016 in Austria and found declining incidence of ICH, but increasing mortality at three months.