Incidence Rate Of Ischemic Stroke Research Articles

Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage

BackgroundPatients with atrial fibrillation and malignant left atrial appendage (LAA) may benefit from LAA closure (LAAC); however, evidence is limited. ObjectiveThe purpose of this study was to determine management strategies and clinical outcomes in patients with atrial fibrillation and malignant LAA. MethodsMalignant LAA was defined as a history of ischemic stroke and/or evidence of LAA thrombus despite continuous oral anticoagulation (OAC) therapy (continuous for ≥3 weeks). We studied 80 patients with malignant LAA treated with LAAC. We compared these patients first against 44 patients with malignant LAA treated with OAC alone and second against 114 patients without malignant LAA who were treated with LAAC for conventional indications. ResultsAmong patients with malignant LAA (first comparison), those treated with LAAC had a higher 1-year cumulative incidence rate of ischemic stroke than did patients treated with OAC alone (6.3% vs 5.3%; log-rank, P = .09) whereas the difference in stroke risk while receiving OAC was comparable (2.7% vs 5.3%; log-rank, P = .84). Furthermore, all disabling stroke events in patients with malignant LAA treated with LAAC occurred only while not receiving OAC. Among patients treated with LAAC (second comparison), those with malignant LAA had a higher 1-year cumulative incidence rate of ischemic stroke (and ischemic stroke due to device-related thrombosis) than did those without malignant LAA (6.3% vs 2.2%; log-rank, P = .009 and 2.2% vs 0%; log-rank, P = .04, respectively). However, these differences in stroke risk were no longer significant while receiving OAC (2.7% vs 1.0%; log-rank, P = .11). ConclusionCombination performing LAAC and continuation of OAC may be options to prevent ischemic stroke in patients with high thromboembolic risk and malignant LAA.

Predictors of ischemic stroke in Chagas disease: Insights into mechanisms beyond cardiomyopathy severity

BackgroundChagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition. MethodsThe study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk. ResultsThe mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775. ConclusionsIn a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.

Acute Ischemic Stroke during Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review of the Literature

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute ischemic stroke patients undergoing ECMO support. The incidence rate of ISs is estimated to be between 1 and 8%, while the mortality rate ranges from 44 to 76%, depending on several factors, including ECMO type, duration of support and patient characteristics. Several mechanisms leading to ISs during ECMO have been identified, with thromboembolic events and cerebral hypoperfusion being the most common causes. However, considering that most of the ECMO patients are severely ill or under sedation, stroke symptoms are often underdiagnosed. Multimodal monitoring and daily clinical assessment could be useful preventive techniques. Early recognition of neurological deficits is of paramount importance for prompt therapeutic interventions. All ECMO patients with suspected strokes should immediately receive brain computed tomography (CT) and CT angiography (CTA) for the identification of large vessel occlusion (LVO) and assessment of collateral blood flow. CT perfusion (CTP) can further assist in the detection of viable tissue (penumbra), especially in cases of strokes of unknown onset. Catheter angiography is required to confirm LVO detected on CTA. Intravenous thrombolytic therapy is usually contraindicated in ECMO as most patients are on active anticoagulation treatment. Therefore, mechanical thrombectomy is the preferred treatment option in cases where there is evidence of LVO. The choice of the arterial vascular access used to perform mechanical thrombectomy should be discussed between interventional radiologists and an ECMO team. Anticoagulation management during the acute phase of IS should be individualized after the thromboembolic risk has been carefully balanced against hemorrhagic risk. A multidisciplinary approach is essential for the optimal management of ISs in patients treated with ECMO.

Climate Change Projections for Stroke Incidence in Taiwan: Impact of 2°C and 4°C Global Warming Level.

This study aimed to establish the exposure-lag-response effect between daily maximum temperature and stroke-related emergency department visits and to project heat-induced stroke impacts under global warming levels (GWL) of 2°C and 4°C. Stroke-related emergency department visits in Taiwan from 2001 to 2020 were identified using the National Health Insurance Research Database (NHIRD). The study population consisted of 1,100,074 initial stroke cases matched with 2,200,148 non-stroke controls. We employed Distributed Lag Nonlinear Models (DLNM) in a case-crossover study to investigate the association between temperature and stroke. Generalized Estimating Equations (GEE) models with a Poisson function were used to correlate high-temperature exposure with annual stroke incidence rates. Projections were made under two global warming scenarios, GWL 2.0°C and 4.0°C, using Coupled General Circulation Model (GCMs). Baseline data from 1995 to 2014 were transformed for spatial distribution at the township level. Geographic Information System (GIS) spatial analysis was performed using Quantum GIS 3.2.0 software. DLNM exposure-lag-response effect revealed that daily maximum temperature exceeding 34°C significantly increased the risk of stroke-related emergency department visits, particularly for ischemic stroke. Under the 2°C GWL scenario, the frequency of days with temperatures surpassing 34°C is projected to rise substantially by the median year of 2042, with a further increase to 92.6 ± 18.0 days/year by 2065 under the 4°C GWL scenario. Ischemic stroke showed the highest increase in temperature-related incidence rates, notably rising from 7.80% under the GWL 2°C to 36.06% under the GWL 4°C. Specifically, the annual temperature-related incidence rate for ischemic stroke is expected to increase significantly by 2065. Regions such as Taichung, Hsinchu, Yilan, and Taitung demonstrated pronounced changes in heat-related ischemic stroke incidence under the GWL 4°C. The findings emphasize the importance of addressing temperature-related stroke risks, particularly in regions projected to experience significant temperature increases. Effective mitigation strategies are crucial to reduce the impact of rising temperatures on stroke incidence and safeguard public health.

Risk of Stroke in Women Using Levonorgestrel-Releasing Intrauterine Device for Contraception.

The commonly used combined hormonal contraceptives with progestins and ethinylestradiol are associated with an increased risk of ischemic stroke (IS). Progestin-only preparations, including levonorgestrel-releasing intrauterine devices (LG-IUDs), are not associated with an increased risk, and in smaller studies, the risk is even reduced. The risk of intracerebral hemorrhage (ICH) has never been investigated. We studied the risk of IS and ICH in women using LG-IUDs compared with women not using hormonal contraceptives. In this Danish historical cohort study (2004-2021), we followed nonpregnant women (18-49 years) registering incident IS and ICH in relation to use of LG-IUDs/nonuse of hormonal contraceptives utilizing Danish high-quality registries with nationwide coverage. Poisson regression models adjusting for age, ethnicity, education, calendar year, and medication use for risk factors were applied. A total of 1 681 611 nonpregnant women contributed 11 971 745 person-years (py) of observation. Mean age at inclusion was 30.0 years; mean length of follow-up was 7.1 years; 2916 women (24.4 per 100 000 py) had IS; 367 (3.1 per 100 000 py) had ICH. Of these, 364 784 were users of LG-IUD contributing 1 720 311 py to the investigation; mean age at start of usage was 34.6 years. Nonusers of hormonal contraceptives contributed 10 251 434 py; mean age at inclusion was 30.0 years. The incidence rate of IS/ICH among LG-IUD users was 19.2/3.0 and among nonusers, it was 25.2/3.1 per 100 000 py. After adjustment, incidence rate ratio for IS was 0.78 (CI, 0.70-0.88), and for ICH it was 0.94 (CI, 0.69-1.28). The use of LG-IUD was associated with a 22% lower incidence rate of IS without raising the incidence rate of ICH. The finding raises the question of whether levonorgestrel, in addition to its contraceptive properties, could have the potential to prevent IS.

Relation between duration of dual antiplatelet therapy and risk of ischemic stroke after stent-assisted treatment of cerebral aneurysm (DAPTS ACE-registry)

BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) in patients with cerebral aneurysm who undergo stent-assisted coil embolization (SACE) has not been established. We aimed to clarify the association between...

Temporal trends of ischemic stroke rates in atrial fibrillation without anticoagulation: a nationwide cohort study from 2007 to 2018

Abstract Background Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown. Purpose To evaluate temporal trends in IS rates in patients with AF who have not initiated oral anticoagulant (OAC) therapy. Methods The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study covers all patients with incident AF in Finland from 2007 to 2018. A four-week quarantine period from AF diagnosis was applied and only follow-up time without OAC therapy was included. IS incidence rates were computed in four-year intervals. Results In total, 129 789 patients with new-onset AF (49.2% women; mean age 71.4 years) were identified. The IS incidence rate trends according to sex and the CHA2DS2-VA score are depicted in the Figure, along with the previously estimated treatment thresholds for direct oral anticoagulants (red broken line) and warfarin therapy (blue broken line). Between the calendar year intervals of 2007-2010 and 2015-2018, their mean CHA2DS2-VA score increased from 2.5 to 3.0, while concurrently the overall IS rate decreased by 25% from 36.7 (95% CI 34.5-39.0) to 27.6 (95% CI 26.1-29.0) events per 1000 patient years. This trend was driven by a 32% decrease in women, particularly among those with high CHA2DS2-VA scores. The overall IS rate in patients with a CHA2DS2-VA score of 1 was 8.2 (95% CI 7.2-9.4) events per 1000 patient years and it remained stable across the study period. Conclusions The IS rates in AF patients without OAC therapy have decreased by 25% between 2007 and 2018, despite their rising stroke risk scores. In patients with a CHA2DS2-VA score of 1 the IS rate appears to be lower than previously assumed and approximately at the threshold at which the potential benefits and harms of OAC therapy have been estimated to overlap.

The Risk of Venous Thromboembolism and Ischemic Stroke Stratified by VTE Risk Following Multiple Myeloma: A Korean Population-Based Cohort Study.

Background: Multiple myeloma (MM) is associated with high morbidity and mortality, with elevated rates of arterial thrombosis and venous thromboembolism (VTE) and ischemic stroke (IS). We aimed to estimate the incidence of VTE and IS categorized by the VTE risk grade among individuals with MM in Korea. Additionally, we explored the potential of the IMPEDE VTE score as a tool for assessing IS risk in patients with MM. Methods: This retrospective cohort study comprised 37,168 individuals aged ≥ 18 years newly diagnosed with MM between January 2008 and December 2021 using the representative claims database of the Korean population. The risk of the incidence of VTE and IS within 6 months after MM diagnosis was stratified based on high-risk (IMPEDE VTE score ≥ 8) and low-risk (<8) categories. The hazard ratios (HRs) were estimated using Cox proportional hazard models. Results: The VTE incidence was 120.4 per 1000 person-years and IS incidence was 149.3 per 1000 person-years. Statistically significant differences were observed in the cumulative incidence rates of VTE between groups with high and low VTE scores (p < 0.001) and between individuals aged ≤ 65 years (p < 0.001) and those with a Charlson comorbidity index (CCI) ≥ 3 compared to lower scores (p < 0.001). Additionally, the cumulative incidence rate of IS differed significantly across all groups (p < 0.001). The HR for the high-risk group in VTE and IS occurrence was 1.59 (95% CI, 1.26-2.00) and 3.47 (95% CI, 2.99-4.02), respectively. Conclusions: It is important to screen and manage high-risk groups for the early development of VTE or IS in patients with newly diagnosed MM.

COVID-19 pandemic and trends in clinical outcomes and medication use for patients with established atrial fibrillation: A nationwide analysis of claims data

Study objectiveThe COVID-19 pandemic disrupted multiple aspects of the health care system, including the diagnosis and control of chronic conditions. This study aimed to quantify pandemic-related changes in the rates of clinical events among patients with atrial fibrillation (AF). Design/setting/participantsIn this retrospective cohort study, we identified individuals with established AF at any time before 2019 using de-identified Optum's Clinformatics® Data Mart, and followed them from 3/18/2019 to death, or disenrollment, or the end of the study (09/30/2021). Main outcomeRates of clinical event, including all-cause hospitalization, ischemic stroke, and bleeding. We constructed interrupted time series to test changes in outcomes after the onset of the COVID-19 pandemic (3/11/2020, date of pandemic declaration). We then identified the first month after the start of the pandemic in which outcomes returned to pre-pandemic levels. ResultsA total of 561,758 patients, with a mean age of 77 ± 9.9 years, were included in the study. The monthly incidence rate of all-cause hospitalization decreased from 2.8 % in the period immediately before the pandemic declaration to 1.7 % in the period immediately after, with p-value for level change<0.001. The rate of new ischemic stroke diagnoses decreased from 0.28 % in the period immediately before pandemic declaration to 0.20 % in the period immediately after, and the rate of major bleeding diagnoses from 0.81 % to 0.59 %, both p-values for level change<0.01. The incidence rate of ischemic stroke and bleeding events returned to pre-pandemic levels in October and November 2020, respectively. ConclusionsThe COVID-19 pandemic was associated with a decrease in health care visits for ischemic stroke and bleeding in a nationwide cohort of patients with established AF.

Abstract P246: Geographical Mapping and Cluster Analysis of Ischemic Stroke in Kentucky

Background: Stroke death is the third leading cause of death in the United States, the sixth leading cause of death in Kentucky (KY), and ischemic stroke (IS) is the most prevalent type in adults (~85%). Small area estimates of stroke incidence can help identify local interventions to lower the burden of vascular risk factors and risk of recurrent IS in these areas. Therefore, the goals of this study are to calculate small area IS incidence rates, examine clusters, and understand the distribution of IS in KY. Methods: Data was obtained from the Kentucky Hospital Inpatient Discharge and Outpatient Services Databases (HIDOSD) from 2012 to 2021; and the Kentucky Cabinet for Health and Family Services. HIDOSD represents KY emergency department discharges, inpatient data, and ambulatory facility services. We linked 5-digit Zip codes to (n=759) zip code tabulation areas (ZCTA) available from the US Census Bureau. The annualized IS rate per 100,000 was calculated by dividing the mean number of IS hospitalizations from 2012 to 2021 by the ZCTA 2020 population. We categorized IS rates by quartiles and calculated box plots in descriptive analyses. We tested for significant spatial clusters using the Local Moran’s I with Empirical Bayes rate smoothing in GeoDa. Results: From 2012-2021, 90,840 IS hospitalizations were reported in KY. The median IS rate was 226.5 per 100,000. The median rate in the highest quartile was 290.8 (IQR 171.7 - 290.8) vs 171.7 (IQR 171.7 - 290.8) in the lowest quartile. An area of high IS rate clusters (n=20) was identified in southeastern KY with lower clusters dispersed throughout the state. Figure. Conclusions: This 10-year analysis of IS hospitalizations across KY identified areas of potential intervention. Future efforts are needed to identify the social and medical contributors driving burden of IS in these areas and to design interventions targeted to improve health outcomes.

Prediction of the 4-Year Incidence Risk of Ischemic Stroke in Healthy Japanese Adults: The Fukushima Health Database.

Estimating the risk of developing ischemic stroke (IS) may assist health professionals in motivating individuals to modify their risk behavior. A predictive model was derived from 178,186 participants from Fukushima Health Database, aged 40-74 years, who attended the health checkup in 2014 and completed at least one annual health checkup by 2018 (Cohort I). Cox proportional hazard regression model was used to build a 4-year prediction model, thus the risk scores were based on the regression coefficients. External validation for the risk scores was conducted in another cohort of 46,099 participants following between 2015 and 2019 (Cohort II). The 4-year cumulated incidence rate of IS was 179.80/100,000 person-years in Cohort I. The predictive model included age, sex, blood pressure, hypertension treatment, diabetes, low- and high-density lipoprotein cholesterol, smoking, walking pace, and body weight change of 3 kg within one year. Risk scores were interpreted based on the Cohort I predictive model function. The Harrell's C-statistics of the discrimination ability of the risk score model (95% confidence interval) was 0.744 (0.729-0.759) in Cohort I and 0.770 (0.743-0.797) in Cohort II. The overall agreement of the risk score probability of IS incidence for the observed/expected case ratio and 95% CI was 0.98 (0.92-1.05) in Cohort I and 1.08 (0.95-1.22) in Cohort II. The 4-year risk prediction model revealed a good performance for IS incidence, and risk scores could be used to estimate individual incidence risk of IS. Updated models with additional confirmed risk variables may be needed.

Abstract TP231: Incidence of Stroke and Transient Ischemic Attack in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis

Introduction: Congenital cardiac lesions result in abnormal flow patterns that increase risk of cerebrovascular events. We investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD). Methods: A systematic review was performed per PRISMA guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were age 16 and older with congenital heart disease, and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% confidence intervals. The Newcastle-Ottawa Scale for risk of bias was applied. This systematic review is registered (CRD42022322144). Results: Of 11,028 identified abstracts, 27 studies met inclusion criteria. 22 studies reported mean or median age, which was less than 60 years in 18 studies. 39 estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person years, with significant heterogeneity between studies (95% CI 0.39-0.86, I2 97.8%, p&lt;0.001). Secondary analyses were performed stratified by CHD and outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person years (95% CI 0.36-0.95, I2 98%, p=0.01). Conclusions: This meta-analysis found that the incidence rate of stroke and TIA is higher in ACHD than age-adjusted global estimates, and similar to the American Heart Association reported global ischemic stroke incidence rate for individuals &gt;60 years (0.52 per 100 person years).

Effects of treatment with clopidogrel with or without proton pump inhibitor omeprazole on the risk of ischemic stroke: a nationwide cohort study

Most proton pump inhibitors (PPIs) inhibit the bioactivation of clopidogrel to its active metabolite. There is controversy concerning whether PPIs alter the effectiveness of clopidogrel in reducing the risk of ischemic stroke (IS). We therefore aimed to examine the risk of IS associated with concomitant use of clopidogrel and omeprazole, a PPI commonly used in clinical settings. We conducted a retrospective cohort study using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohorts comprised 407 patients diagnosed with acute coronary syndrome (ACS) and with concomitant use of clopidogrel and omeprazole (the exposed cohort), 814 ACS patients with single use of clopidogrel (the comparison cohort), and 230 ACS patients with concurrent use of clopidogrel and pantoprazole (the reference cohort). The primary outcome was incident IS. The hazard ratios (HRs) and 95% confidence intervals (CIs) derived from the time-dependent Cox regression model were used to assess the association between concomitant use of clopidogrel and omeprazole and the risk of IS. The incidence rate of IS was significantly higher in the exposed cohort (81.67 per 1000 person-years) than in the comparison cohort (57.45 per 1000 person-years), resulting in an adjusted HR of 1.39 (95% CI 1.03–1.74). By contrast, there was no significant difference in the risk of IS between the exposed and reference cohorts (adjusted HR 1.11; 95% CI 0.81–1.52). The present study revealed that patients taking both clopidogrel and omeprazole was associated with an increased risk of IS.

Incidence and risk of stroke in Korean patients with congenital heart disease

ObjectivesThe incidence and risk of ischemic stroke (IS) and hemorrhagic stroke (HS) in Korean patients with CHD have not been reported, therefore, we aimed to investigate this. Materials and MethodsParticipants were selected from the Korean National Health Insurance Service benefit records from 2006-2017. Cases were extracted using diagnosis codes related to CHD. Controls without CHD were selected through age- and sex-matched random sampling at a 1:10 ratio. ResultsThe case and control groups included 232,203 and 3,024,633 participants, respectively. The median (interquartile range) follow-up period was 7.28 (3.59-8.73) years. The incidence rates of IS and HS per 100,000 person-years were much higher in cases than in controls (IS: 135 vs. 47; HS: 41.7 vs. 24.9). After adjusting for confounders, CHD was a risk factor for IS and HS (subdistribution HR; 1.96 and 1.71, respectively). In patients with CHD, the following risk factors were identified: diabetes, heart failure, and atrial fibrillation for any stroke; hypertension, atrial septal defects, and use of antiplatelet agents for IS only; and coronary artery bypass graft surgery for HS only. ConclusionsKorean patients with CHD have a high risk of stroke. A personalized preventive approach is needed to reduce the incidence of stroke in this population.

Change in incidence of ischemic stroke and mortality among patients with atrial fibrillation over a period of 30 years, a nationwide, register-based cohort study

Abstract Background During the last decades we have faced large changes in lifestyle and cardiovascular risk factor patterns, as well as screening and treatment advances of patients with atrial fibrillation (AF). Aim To investigate trends in ischemic stroke (IS) and mortality in Sweden over a period of 30 years among patients with AF and compare it to matched controls without AF. Methods This is a Swedish nationwide registry-based retrospective case-control study of patients diagnosed with AF combining data from National Patient Register (NPR) and Cause of Death Register between 1987 and 2018. Controls were defined as Swedish inhabitants without AF and matched by age, sex and county. With the use of international classification of diseases (ICD) 9- and 10- codes we identified all patients diagnosed with AF, and comorbidities at baseline from NPR. Results In total, we identified 739,388 patients with AF and 1,386,448 matched controls. The mean age of the study population was 78.8 (12.6); and (46.2%) were female. Cochran-Armitage test showed a significant increase of all comorbidities over time, except for myocardial infarction for patients and PAH för controls. The Incidence rate for IS per 1000 person-year within one year declined from 40.9 (95% C.I.: 30.1-55.6) in 1987 to 16.2 (95% C.I.: 9.9-26.4) in 2017 (p &amp;lt;.0001) for patients with AF and from 12.2 (95% CI: 7.0-21.4) in 1987 to 6.2 (95% CI: 2.8-13.7) in 2017 (p &amp;lt;.0001) in controls. The prescription of oral anticoagulant therapy (OAK) increased from 40% in 2006 to almost 80% in 2018. The total 1-year mortality rate of IS was at 175.4 (151.3-203.4) for AF cases and 58.3 (45.1-75.4) for controls (p&amp;lt;0001). Compared to controls and adjusted for age, sex and comorbidities patients had HR for IS at 3.01 (95% CI: 2.89-3.13) between 1987 and 1999 that decreased to HR 2.75 (95% CI: 2.63-2.88) between 2010 and 2017 in patients with AF. After adjustment for baseline comorbidities and OAK the one-year risk for IS decreased from HR 1.01 (95% CI: 0.95-1.08) in 2012 to 0.41 (95% CI: 0.36-0.47) in patients and HR 0.50 (95% CI: 0.43-0.58) in 2012 to 0.37 (95% CI: 0.31-0.43) in controls, respectively (both p&amp;lt;0.0001). Conclusions This study revealed significant prognostic improvement of patients with AF showing decrease in the incidence rate and relative risk for IS, as well as all-cause mortality within one year of AF diagnose. The prescription of OACs almost doubled between 2006 and 2018 in patients with AF and was associated with a significant decrease of the relative risk for IS to almost same level as in controls without AF.

Abstract 16129: The Gender Difference in Risk Factors and Incidence Rate of Ischemic Stroke in Japanese Atrial Fibrillation Patients: The Fushimi AF Registry

Background: Gender-specific medicine is of concern in cardiovascular medicine. We previously reported that there was not gender difference in the incidence of ischemic stroke from the Fushimi AF Registry. However, the gender difference in risk factors of ischemic stroke in Japanese atrial fibrillation (AF) patients is little known. The aim of this study is to compare the risk factors and incidence rate of ischemic stroke in male and female using the latest data with longer follow-up. Method: In the Fushimi AF Registry, follow-up data were available for 4,496 patients. In the entire cohort, 2,677 were male and 1,819 were female. We compared clinical characteristics and risk factors and incidence rate of ischemic stroke between the two groups. Result: Male patients were younger (male vs. female; 71.5 years vs. 76.7 years, p&amp;lt;0.01), greater in body weight (65.0 kg vs. 51.2 kg, p&amp;lt;0.01), were more often sustained type (52.0% vs. 48.2%, p=0.04), more likely to have diabetes mellitus (26.2% vs. 19.9%, p&amp;lt;0.01), coronary artery disease (16.0% vs. 12.3%, p&amp;lt;0.01) and less likely to have prior heart failure (24.0% vs. 32.3%, p&amp;lt;0.01), chronic kidney disease (CKD) (33.7% vs. 39.3%, p&amp;lt;0.01) and had lower CHADS 2 score (1.96 vs. 2.15, p&amp;lt;0.01). In prescription data, male patients more often received oral anticoagulant (58.2% vs. 52.1%, p&amp;lt;0.01) and antiplatelet drug (APD) (29.0% vs. 23.8%, p&amp;lt;0.01). Hypertension, left atrium enlargement (LAE), previous stroke and major bleeding were comparable between the two groups. During the median follow-up of 1,824 days (longest 10 years), the incidence rate of ischemic stroke was not significantly different between two groups (0.86 vs. 0.89% per person-year, log rank p=0.32). On multivariate Cox regression analysis, age, previous stroke and LAE were significantly associated with an increased risk of ischemic stroke in both groups. CKD and prescription of APD were significantly associated with an increased risk of ischemic stroke in male, while body weight was in female. Conclusion: The incidence rate of ischemic stroke was not significantly different between male and female. The risk factors associated with ischemic stroke were different between male and female in Japanese AF patients.

Risk factors for stroke recurrence in young patients with first-ever ischemic stroke: A meta-analysis.

At present, the incidence rate of ischemic stroke in young people is increasing yearly, and the age of onset is increasingly young. Therefore, primary and secondary prevention of ischemic stroke in young people, especially secondary prevention, is particularly crucial. We aimed to comprehensively evaluate risk factors for stroke recurrence in first-ever young ischemic stroke (YIS) patients. The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally. Stata12.0 software was used for heterogeneity testing, publication bias analysis, sensitivity analysis, and the calculation of combined odds ratios and 95% confidence intervals. The odds ratio (OR) values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54 (1.05-2.26) and 1.12 (1.00-1.25), respectively. The OR values of male sex, type 2 diabetes, smoking, drinking and YIS recurrence were 1.66 (0.98-2.79), 1.01 (0.64-1.59), 1.21 (0.83-1.76), and 1.28 (0.82-2.53), respectively. The relationship between male sex, type 2 diabetes, smoking, drinking and YIS recurrence was ambiguous. Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients, and active intervention should be taken.

Global and national burden of atherosclerosis from 1990 to 2019: trend analysis based on the Global Burden of Disease Study 2019.

Atherosclerosis-related diseases represent significant health issues among adults globally. Despite their widespread impact, comprehensive data concerning the global and national burden and trends of these diseases remain sparse. Our objective is to examine the trends in the burden of atherosclerosis among adults from 1990 to 2019 at both global and national levels. We reported the average annual percentage changes (AAPCs) in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of atherosclerosis-related diseases (ischemic heart disease [IHD], ischemic stroke, and peripheral arterial disease [PAD]) at the global and national levels among individuals based on a trend analysis of the Global Burden of Diseases Study (GBD) 2019. We further analyzed these global trends as a function of age, gender, and the social development index. We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends. Globally, the AAPC of IHD incidence rose from 1990 to 2019 (0.20; 95% confidence interval [CI], 0.12-0.28), with substantial surges in 1995, 2001, 2005, 2010, and 2017. Conversely, AAPC of IHD mortality rates exhibited a different trend until a rise in 2014. The AAPC of incidence rates of ischemic stroke and PAD also escalated during the same period, with respective 0.43 (95% CI, 0.39-0.48) and 0.13 (95% CI, 0.06-0.21). For ischemic stroke, both incidence and mortality soared in 2014, while PAD incidence declined in 1994 and 1998, then sharply climbed in 2016. Nationally, the Northern Mariana Islands experienced the steepest increase in IHD and PAD incidence and mortality between 1990 and 2019. China saw a significant rise in ischemic stroke incidence, whereas the highest mortality rate increase occurred in Timor-Leste. By sociodemographic index (SDI) quintile, low-middle-, middle-, and high-middle-SDI countries all showed upward trends in IHD, ischemic stroke, and PAD incidence. Simultaneously, IHD and ischemic stroke mortality rates, as well as DALYs, dropped in the low-, high-middle-, and high-SDI nations. However, PAD mortality rates and DALYs saw an uptick across all SDI quintiles. Regarding age demographics, a global decrease in the AAPC IHD incidence as noted in individuals above 55 years old, in contrast to an increase in the 20-55 age group during this period. AAPC of mortality rates for IHD, ischemic stroke, and PAD decreased across all ages. The AAPC showed an increase in IHD incidence in both genders. Conversely, IHD's DALYs saw a reduction in both males and females. Ischemic stroke patterns mirrored these trends, whereas all measures for PAD exhibited growth for both sexes. From 1990 to 2019, there was an overall increasing trend in the global incidence of all three clinical manifestations of atherosclerosis. Between 1990 and 2019, both the mortality rate and DALYs for IHD and ischemic stroke declined across all age groups. Overall, the burden of atherosclerosis-related diseases has not significantly decreased and even shows signs of trending upward. These findings strongly suggest that despite some progress made, efforts to control atherosclerosis diseases globally need to be intensified.

Effect of a two-phase tobacco control regulation on incidence from ischemic stroke and hemorrhagic stroke, Shenzhen, China, 2007-2016.

The Shenzhen government is widely considered to be most efficiently implementing smoke-free legislation in China. We evaluated and compared the impact of Shenzhen's two-phase smoke-free regulation on the incidence rates for ischemic and hemorrhagic stroke. An interrupted time series design was used to capture immediate and annual incidence changes from 2007 to 2016 for both ischemic and hemorrhagic stroke due to two-phase smoke-free regulation in Shenzhen, China, by using a generalized additive model. The first phase, implemented on 9 March 2010, required five main public places to be smoke-free. In the second phase, the comprehensive law was expanded to the whole city on 1 March 2014. The regulation implementation during phase I was associated with a strong immediate decline in the incidence rate of ischemic stroke (-14.2%, 95% CI: -19.6 - -8.4) and hemorrhagic stroke (-10.1%, 95% CI: -18.2 - -1.2), but without showing the annual changes (p>0.05). Following the implementation of the comprehensive law, the gradual annual effect showed a significant change in ischemic stroke, with a 6.3% (95% CI: 8.9 - -3.6) reduction. Neither the immediate nor gradual decreases in hemorrhagic stroke incidences associated with the comprehensive regulation were statistically significant during phase II (p>0.05). Subgroup analyses indicate that a much larger health effect of the regulation during phase I was greater among those aged ≥65 years than among those aged 35-64 years. Shenzhen's two-phase smoke-free regulation was well implemented. Even though the regulation did not extend to the whole city, the immediate health benefits on the incidence rates of ischemic stroke and hemorrhagic stroke could be seen. However, the health benefits brought by the implementation of comprehensive smoke-free legislation were attenuated by previous smoke-free regulations in five main public places, which were more evident in hemorrhagic stroke.

Burden and attributable risk factors of ischemic stroke in China from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019.

The epidemiologic characteristics and attributable risk factors of ischemic stroke in China have changed over the past three decades. An up-to-date analysis on deaths, disability-adjusted life-years (DALYs), prevalence, incidence, and attributable risk factors of ischemic stroke for China is needed. This study aims to provide a comprehensive analysis of burden and attributable risk factors of ischemic stroke at national level in China by sex from 1990 to 2019. This is a secondary analysis of the Global Burden of Disease (GBD) study 2019. All data used in this study was derived from the 2019 GBD study. Deaths, DALYs, prevalence, incidence, and attributable risk factors of ischemic stroke in China by sex from 1990 to 2019 were analyzed. From 1990 to 2019, the age-standardized deaths rate decreased by 3.3%, age-standardized DALYs rate decreased by 4%, age-standardized prevalence rate increased by 33.5%, and age-standardized incidence rate of ischemic stroke in China increased by 34.7%. In 2019, ambient particulate matter pollution became an important risk factor, whereas household air pollution from solid fuels was no longer a major risk factor for ischemic stroke in China. Burden of ischemic stroke was higher in China compared to other regions. Ambient particulate matter pollution among men, and diet high in sodium, smoking, household air pollution from solid fuels among women account for the increased deaths/DALYs due to ischemic stroke in China. Our study revealed that great changes have occurred in burden and attributable risk factors of ischemic stroke in China in the past three decades. Distinct sex-specific differences are observed in burden and attributable risk factors.