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BackgroundData on oral anticoagulant-related (OAC) intracerebral hemorrhage (ICH) incidence are scarce. Most studies on incidence time trends were performed before the introduction of Direct Oral Anticoagulants (DOACs). Between 2008 and 2018, the number of OAC-users in the Netherlands increased by 63%, with the number of DOAC-users almost equaling that of Vitamin K Antagonists (VKA)-users. We aimed to determine the recent total and OAC-related ICH incidence and assess changes over the last decade, including the effect of DOAC introduction.MethodsAll adult non-traumatic ICH patients presenting in any of three hospitals in the enclosed region of South-Limburg, the Netherlands, were retrospectively included, during two 3-year time periods: 2007–2009 and 2017–2019. OAC-related ICH was defined as ICH in patients using VKAs or DOACs. We calculated the incidence rate ratio (IRR) between the two study periods.ResultsIn the 2007–2009 period, we registered 652 ICHs of whom 168 (25.8%) were OAC-related (all VKA). In the 2017–2019 period, we registered 522 ICHs, 121 (23.2%) were OAC-related (70 VKA and 51 DOAC). In 2007–2009, the annual incidence of total ICH and OAC-related ICH was 40.9 and 10.5 per 100,000 person-years, respectively, which decreased to 32.4 and 7.5 per 100,000 person-years in 2017–2019. The IRR for total ICH and OAC-related ICH was 0.67 (95%-CI: 0.60–0.75) and 0.58 (0.46–0.73), respectively.ConclusionBoth total ICH and OAC-related ICH incidence decreased over the past decade in South-Limburg, the Netherlands, despite the aging population and increasing number of OAC-users. The introduction of DOACs, and possibly an improved cardiovascular risk management and change in OAC prescription pattern, could explain these findings.

Little is known about the association between spicy food intake, dietary approaches to stop hypertension (DASH) score, and incident stroke. This study aimed to explore the association of eating spicy food, DASH score, and their interaction with stroke incidence. We included 22,160 Han residents aged 30–79 in southwest China from the China Multi-Ethnic Cohort. Three hundred and twelve cases were newly diagnosed with stroke by October 8, 2022, during a mean of 45.5 months of follow-up. Cox regression analyses showed that eating spicy food reduced stroke risk by 34% among people with low DASH scores (HR 0.66, 95%CI 0.45–0.97), while individuals with high DASH scores versus low DASH scores had a 46% lower stroke incidence among spicy food nonconsumers (HR 0.54, 95%CI 0.36–0.82). The HR of the multiplicative interactive term was 2.02 (95%CI 1.24–3.30) and the overall estimates of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and the synergy index (S) were 0.54 (95%CI 0.24–0.83), 0.68 (95%CI 0.23–1.14), and 0.29 (95%CI 0.12–0.70), respectively. Consuming spicy food seems to be associated with lower stroke risk only in people who have a lower DASH score, while the beneficial effect of higher DASH scores seems to be found only among nonconsumers of spicy food, and a negative interaction may exist between them in southwestern Chinese aged 30–79. This study could provide scientific evidence for dietary guidance to reduce stroke risk.

Background No studies have examined the associations between adult height and ischemic stroke subtypes. Methods We conducted a population-based case-control study that included 2,451 thrombotic and 687 embolic stroke cases, as well as 1,623 intracerebral and 768 subarachnoid hemorrhage cases without history of stroke aged 40-79 years, and the same number of sex- and age-matched controls. Cases and controls were grouped according to the quintile cut-off values of height in controls, and the third quintile, which was approximately the average height group, was used as the reference group. Height was also examined as a continuous variable as divided by one standard deviation of height in controls. The analyses were carried out separately for participants aged 40-59 years and 60-79 years. Results In both younger and older men, continuous height was linearly inversely associated with total and thrombotic strokes, and the shortest quintile compared to the reference was associated with increased risks of these strokes. Although height was linearly inversely associated with embolic stroke and intracerebral hemorrhage in younger men, the shortest quintile did not show increased risks of these strokes. Height did not seem to be associated with total stroke and any stroke subtypes in younger women. In contrast, the tallest quintile was significantly associated with increased risks of total stroke and intracerebral hemorrhage, and height tended to be positively associated with these strokes in older women. Conclusions We reported the associations between adult height and ischemic stroke subtypes for the first time, which differed according to sex and age-group.

Background and Purpose: Previous studies of stroke management and outcome in Sweden have revealed differences between men and women. We aimed to analyze if differences in stroke incidence, care, and outcome have altered over time. Methods: All stroke events registered in the Swedish Stroke Register 2005 to 2018 were included. Background variables and treatment were collected during the acute hospital stay. Survival data were obtained from the national cause of death register by individual linkage. We used unadjusted proportions and estimated age-adjusted marginal means, using a generalized linear model, to present outcome. Results: We identified 335 183 stroke events and a decreasing incidence in men and women 2005 to 2018. Men were on average younger than women (73.3 versus 78.1 years) at stroke onset. The age-adjusted proportion of reperfusion therapy 2005 to 2018 increased more rapidly in women than in men (2.3%–15.1% in men versus 1.4%–16.9% in women), but in 2018, women still had a lower probability of receiving thrombolysis within 30 minutes. Among patients with atrial fibrillation, oral anticoagulants at discharge increased more rapidly in women (31.2%–78.6% in men versus 26.7%–81.9% in women). Statins remained higher in men (36.9%–83.7% in men versus 32.3%–81.2% in women). Men had better functional outcome and survival after stroke. After adjustment for women’s higher age, more severe strokes, and background characteristics, the absolute difference in functional outcome was Conclusions: Stroke incidence, care, and outcome show continuous improvements in Sweden, and previously reported differences between men and women become less evident. More severe strokes and older age in women at stroke onset are explanations to persisting differences.

Background and Purpose: COVID-19 is associated with systemic thromboembolism including stroke. The study evaluated the 30-days stroke incidence in SARS-CoV-2 PCR positive patients and described the outcome of such patients. Methods: This is a retrospective study of consecutive patients with a positive SARS-CoV-2 PCR test between March 1st, 2020 and August 30th, 2020. The study included COVID-19 patients who were hospitalized and had a stroke within 30 days from the positive PCR test. Results: During the study period, there were 4301 patients with a positive SARS-CoV-2 PCR test. Of those, 1786 patients (41.5%) were hospitalized and 4 patients developed a stroke within 30 days. The 30-days stroke incidence was 0.09% and 0.2% of all and hospitalized patients, respectively. The mean age of stroke patients was 78 years and 2 died during the same hospitalization. The 4 patients had comorbidities, one had pre-existing atrial fibrillation and all had ischemic stroke. Conclusion: This study showed a low 30-day incidence of stroke among COVID-19 patients.

Objective: China has the highest stroke incidence in the world, with a large percentage of post-stroke depression (PSD). Abdominal acupuncture is used frequently to treat PSD. This research systematically evaluated the clinical efficacy of this treatment for PSD. Methods: A literature search retrieved randomized controlled trials in English and Chinese on abdominal acupuncture in conjunction with other therapies (experimental groups), compared to conventional therapies (control groups) for treating PSD from January 2000 to November 2020. Literature quality was evaluated with the Cochrane Library bias-risk assessment tool. RevMan5.3 software was used for the meta-analysis. Results: A total of 10 RCTs involving 708 patients were evaluated. Hamilton Depression Scale scores of the experimental groups were significantly lower than in the control groups (mean difference [MD] = −2.34; 95% confidence interval [CI]: −2.89, −1.78; P

Controversial results have been reported about the association of calcium, magnesium, and phosphorus and stroke risk, but none in China. To investigate the association between dietary calcium, magnesium, phosphorus, and stroke incidence in Chinese adults, we collected data from the China Health and Nutrition Survey (CHNS) from 2004 to 2011, including 6411 participants aged 45–79 years and free of stroke at baseline. Diet was assessed by interviews combining 3-d 24-h food recalls and household food inventory weighing at each survey round. The stroke incident was identified based on the validated self-report. Multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For 32,024 person-years of follow-up, 179 stroke cases were documented. After adjustment for major lifestyle and dietary risk factors, calcium intake was positively associated with reduced stroke risk, and the HR of stroke comparing extreme quartiles was 0.53 (95% CI 0.29–0.96, Ptrend = 0.03). In further stratified analyses, significant heterogeneity across sex strata was found (Pinteraction = 0.03). Dietary calcium intake among men was more inversely related to stroke, with HRs being 0.33 (95% CI 0.15–0.76, Ptrend = 0.02), compared to 1.24 (95% CI 0.46–3.35, Ptrend = 0.89) among women. However, no significant association between stroke and magnesium or phosphorus was revealed. Our findings suggest that higher dietary calcium intake was associated with a lower risk of stroke in Chinese adults, particularly in men.

We examined the longitudinal association between blood pressure (BP) and stroke incidence in young and middle-aged adults. BP measured during 9 examinations of the CARDIA study (Coronary Artery Risk Development in Young Adults) from 1985-1986 to 2015-2016 was used to classify participants (n=5079) according to the 2017 Hypertension Clinical Practice Guidelines. We used the highest BP obtained through the third examination (1990–1991) to define baseline BP categories; time-dependent categories (accounting for change in BP over time) were determined incorporating follow-up measurements. BP groups at ages 30 and 40 years were also defined. Stroke events were adjudicated until 2018. Mean age at baseline was 29.8 years. Stroke occurred in 100 participants. Stroke incidence (per 100 000 person-years) was higher ( P

Background and Purpose: Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort. Methods: Adults age 50+ in the HRS (Health and Retirement Study) were followed across three successive 6-year epochs (epoch 1: 1998–2004, n=16 781; epoch 2: 2004–2010, n=15 345; and epoch 3: 2010–2016; n=15 949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change before stroke, at the time of stroke, and for years following stroke. Results: Crude stroke incidence rates decreased from 8.5 per 1000 person-years in epoch 1 to 6.8 per 1000 person-years in epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from −0.37 points (95% CI, −0.44 to −0.29) in epoch 1 to −0.26 (95% CI, −0.33 to −0.18) points in epoch 2 and −0.25 (95% CI, −0.33 to −0.17) points in epoch 3 ( P value for linear trend=0.02). Conclusions: Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.

This longitudinal study was designed to evaluate the association between acute prestroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe prestroke stress in the two weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute prestroke stress and study outcomes. Among 624 patients with FES, 169 reported acute prestroke stress. Patients with acute prestroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p

Objective: To identify the risk factor of Stroke in health institution employees. Method: The research design was cross-sectional with 107 people who participated in this survey using purposive sampling method. Results: The relationship between family history with the incidence of stroke obtained p value (p 0.05), lack of consumption of fruits and vegetables obtained a value of p = 0.091 (p > 0.05) and alcohol consumption with the incidence of stroke obtained a value of p = 0.616 (p > 0.05). Conclusions: Relationship between family history, smoking habits with the incidence of stroke.

Race/ethnic minorities face significant inequities in stroke incidence, prevalence, care, and outcomes. The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving symposium, a collaborative initiative of the American Heart Association and National Institute of Neurological Disorders and Stroke, was the first-ever annual multidisciplinary scientific forum focused on race/ethnic inequities in cerebrovascular disease, with the overarching goal of reducing inequities in stroke and accelerating the translation of research findings to improve outcomes for race/ethnic minorities. The symposium featured esteemed invited plenary speakers, lecturing on determinants of race/ethnic inequities in stroke and interventions aimed at redressing the inequities. The Edgar J. Kenton III Award recognized Ralph Sacco, MD, MS, for his lifetime contributions to investigation, management, mentorship, and community service in the field of stroke inequities. Early career investigators were provided with travel awards to attend the symposium; presented their research at moderated poster and Think Tank sessions; received career development advice at the Building Momentum session; and networked with experienced stroke inequities researchers. Future conferences—The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving 2021 to 2024—will broaden the focus to include 5 major persistent inequities (race/ethnic, sex, geographic, socioeconomic, and global). Each year will focus on a different theme (community and stakeholder engagement; clinical trials; implementation science; and policy and dissemination). By fostering a community of stroke inequities researchers, we hope to highlight promising work, illuminate research gaps, facilitate networking, inform policy makers, recognize achievement, inspire greater interest among junior investigators to pursue careers in this field, and provide networking opportunities for underrepresented minority scientists.

Objectives Evidence of the association between fine particulate (PM2.5, particles≤2.5 μm in aerodynamic diameter) air pollution and fatal hemorrhagic stroke incidence is limited. This study aims to document the relationship between PM2.5 exposure and fatal hemorrhagic stroke incidence. Methods The time-stratified case-crossover approach was applied for the analysis. Results The mean concentration of PM2.5 is 75.33 ug/m. Fatal hemorrhagic stroke incidence was significantly associated with PM2.5 exposure. Exposure to PM2.5 led to a 5% (2%-9%) and 5% (1%-10%) increase in fatal hemorrhagic stroke incidence in lag2 and lag03 respectively. An increased risk was observed especially in men and subjects with hypertension. Conclusions This study provides evidence for the association between PM2.5 exposure and fatal hemorrhagic stroke incidence. Men and subjects with hypertension have increased risks, overweight may further increase their susceptibility to PM2.5 exposure related hemorrhagic stroke.

Supplemental Digital Content is available in the text., Background and Purpose— Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods. Methods— Data from OCSP (Oxfordshire Community Stroke Project; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2017) along with other published population-based stroke incidence studies that reported temporal trends of stroke incidence since 1990 in high-income countries were included. Age-standardized relative incidence rate ratios were calculated for each study and then pooled with inverse-variance weighted random-effects meta-analysis. Projection estimates were calculated for the number of incident stroke patients in the United Kingdom from year 2015 to 2045. Results— In Oxfordshire, stroke incidence fell by 32% from OCSP to OXVASC, with a similar trend before or after year 2000. With the projected aging population, if the age-specific stroke incidence continued to decrease at its current rate (6% every 5 years), there would still be a 13% increase of the number of first-ever strokes in the United Kingdom up to year 2045. Incorporating the Oxfordshire data with other 12 population-based studies, stroke incidence declined steadily between the 1990s and 2010s within each study, resulting in a 28% decline over an average period of 16.5 years (pooled incidence rate ratio, 0.72 [95% CI, 0.66–0.79]; P

Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deteriorate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable. © 2020 Literatura Medica Publishing House. All rights reserved.

Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands. Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation. Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5. Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 [6–8]. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes. Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.

Background:Using a population-based stroke registry system, we evaluated the relationship between ambient temperature parameters and stroke incidence in a Japanese population., Methods and Results:We analyzed data from the Takashima Stroke Registry, which records all stroke occurrences in Takashima City, Japan. The study period of 8,401 days was divided into quintiles of daily weather parameters, and the middle quintile was used as the reference category. Incidence rates (IR per 100,000 person-years) were calculated across the quintiles. Poisson regression analysis was used to calculate the effect of temperature parameters on stroke incidence. There were 2,405 first-ever strokes (1,294 men), including 1,625 ischemic, 545 cerebral hemorrhages, 213 subarachnoid hemorrhages, and 22 unclassified strokes. The stroke IR was higher in the middle quintile of average temperature, 357.3 (328.4–388.8), and for other parameters. After adjustment for age and sex, for all stroke, the incidence rate ratio (IRR) in the highest (Q5: IRR 0.81, 95% confidence interval (CI) 0.71–0.92) and the second-highest (Q4: IRR 0.80, 95% CI 0.71-0.91) quintile was lower than that in the middle quintile (Q3: Reference). Analogous results were observed for the minimum, maximum, and lag-days temperatures, also in the subtypes and across ≥65 years of age, also in females., Conclusions:Higher temperatures, irrespective of the parameter (average, minimum, or maximum), had a protective effect against stroke occurrence in Japan.

Background Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections towards year 2040. Methods All recorded strokes in Norway between 2010 and 2015 were extracted from the National Patient Registry and the National Cause of Death Registry. We report incidence by age, sex, and year; in raw numbers, per 100,000 person-years, by WHO and European standard populations; and generated statistical models by stroke type, age, sex, and year; and projected stroke incidence toward year 2040. Results The data covered 30.1 million person-years at risk, 53431 unique individuals hospitalized with a primary stroke diagnosis, and 6315 additional individuals registered as dead due to stroke. From 2010 to 2015, individuals suffering stroke per 100,000 person-years dropped from 239 to 195 (208 to 177 excluding immediate deaths). The decline was driven by ischemic strokes, with a statistically non-significant time trend for hemorrhagic stroke. Conclusions The age-dependent incidence of ischemic strokes in Norway is declining rapidly, and more than compensates for the growth and ageing of the population. Comparisons with historic incidence statistics show that the reduction in incidence rates has accelerated over the last two decades.

Background Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. Methods We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017. Results Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3–161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0–1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9–82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1–71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries. Conclusions Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.

Summary Pickles are a salty, oily food item which form a regular part of Indian diets. Both high salt and high fat diet are risk factors for stroke. We studied 112 stroke patients and 100 non afflicted controls regarding their dietary pickle ingestion as a case control study. The percentage of pickle exposure was similar in stroke patients and controls. (63.4% vs 56%, p = 0.27). The quantity of pickle intake per day was more in stroke patients than in controls. p = 0.008. However, the mean number of years of pickle intake was lower in stroke patients than in controls. (18.7 vs 24.2), p = 0.02. Hence the relationship between pickle intake and stroke incidence is complicated. A large cohort study might elucidate the association.

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.

Objective: This study aimed to evaluate the demographic, etiologic, and clinical characteristics of patients with the diagnosis of stroke, as well as the incidence of stroke in Ardahan province, which is the gateway from our country to the Caucasus (Caucasia). Materials and Methods: This study has a descriptive design. The hospital records of patients who were diagnosed as having stroke or cerebrovascular disease between June 2015 and June 2016 in Ardahan State Hospital were retrospectively investigated. Results: In the defined one year period, 196 individuals were admitted to our hospital with the diagnosis of acute stroke. The incidence of stroke was 199/100.000 per person-year. Of these patients, 71.4% (n=140) were diagnosed as having ischemic stroke and 20.4% (n=40) had hemorrhagic stroke. The incidence of ischemic stroke was determined as 142/100.000 per person-year. The incidence of hemorrhagic stroke was determined as 41/100.000 per person-year. Ipsilateral muscle weakness was the most common symptoms in 78.1% (n=153) of the patients. Of the patients, 3.6% (n=7) were admitted to the hospital within 3 hours after the onset of symptoms and 75.5% (n=148) were brought to our hospital by ambulance Conclusion: Although the results of this study are generally compatible with other studies in the literature, they also show differences. The incidence of stroke in our country and the demographic characteristics of patients with stroke differ from other countries, at the same time there may be regional differences. For this reason, the data in this study are important because they provide information about our country and its northeastern region.

Highlights • Walking pace has been considered a predictor of future adverse health endpoints. • An inverse association was documented between walking pace and stroke risk. • With every 1 km/h increment in walking pace, the stroke risk was decreased by 13%. • Specific cut-off values for walking pace is needed, such as age, gender, etc., Purpose The extent to which walking pace is associated with a reduced risk for stroke remains unclear. This study examined the association between walking pace and stroke risk based on prospective cohort studies. Methods Databases of PubMed, EMBASE, Web of Science, Scopus, and China National Knowledge Internet were searched from the inception dates to January 31, 2019, for prospective cohort studies focusing on walking pace and risk of stroke in adults. Two reviewers independently extracted data and assessed the quality of the studies. The dependent measure was stroke incidence. Using random-effects models, a meta-analysis was performed to estimate the overall relative risks (RR) of stroke incidence and 95% confidence intervals (CIs) for the individuals with the fastest walking paces vs. individuals with the slowest walking paces. A dose-response relationship was also examined. Results After screening 1294 titles/abstracts and 14 full-text studies identified in the search, 7 studies (from 8 cohorts) were included in the meta-analysis. The 7 studies included a total of 135,645 participants (95.2% women; mean age 63.6 years) and 2229 stroke events (median follow-up time = 8.0 years). Compared to individuals in the slowest walking-pace category (median = 1.6 km/h), individuals in the fastest walking-pace category (median = 5.6 km/h) had a 44% lower risk of stroke (pooled RR = 0.56, 95%CI: 0.48–0.65). There was also a linear dose-response relationship (RR = 0.87; 95%CI: 0.83–0.91), with the risk of stroke decreased by 13% for every 1 km/h increment in baseline walking pace. We observed similar results across walking-pace assessment, type of stroke ascertainment, stroke subtypes, sex, sample size, and duration of follow-up. Conclusion Findings from this meta-analysis indicate that walking pace is inversely associated with the risk of stroke., Graphical abstract Image, graphical abstract

Background: Stroke is a brain attacks caused by blockage or rupture of brain blood vessels. Until now, stroke is unknown causes. Some risk factors may effect in increasing of stroke incidence. Aim : This study aimed to determine the risk factors influenced incident of stroke in the Stroke Corner, Tabanan Hospital. Methods : This research was a retrospective descriptive study involved 172 patients who had been treated in Stroke corner. Data were collected by chart-reviewed. Further, data were analyzed descriptively using SPSS for windows 17.0. Results : Findings found that majority of respondents aged over 65 years (39%) with male (53.5%). The results of this study also showed that there were three of highest risk factors influenced stroke incident such as hypertension (41.2%), diabetes mellitus (15.1%), and cardiac problem (7.6%). Conclusion : Although the cause of stroke is unknown but several factors such as hypertension, diabetes and heart problems greatly contribute to the incidence of stroke. Therefore, it is essential for health personnels to be more focused in managing risk factor for recurrent stroke prevention.

Objective— Increased Lp(a) [lipoprotein(a)] is associated with coronary heart disease risk, but links with stroke are less consistent. Blacks have higher Lp(a) levels and stroke incidence than whites but have been underrepresented in studies. We hypothesized that Lp(a) is a risk factor for ischemic stroke and that risk differs by race. Approach and Results— REGARDS (Reasons for Geographic and Racial Differences in Stroke) recruited 30 239 black and white US adults aged ≥45 in 2003–2007 to study regional and racial differences in stroke mortality. We measured baseline Lp(a) by immunonephelometric assay in 572 cases of incident ischemic stroke and a 967-person cohort random sample. The hazard ratio of stroke by baseline Lp(a) was calculated using Cox proportional hazards models, stratified by race. Lp(a) was modeled in sex- and race-specific quartiles, given known differences in distributions by race and sex. Interactions were tested by including interaction terms in the proportional hazards models, with P P interaction=0.12. Lp(a) was lower in men than women, but associations with stroke in men and women were similar. Conclusions— We confirm that Lp(a) is a risk factor for ischemic stroke. Further research is needed to confirm the role of racial differences of the Lp(a) risk multiplier in ischemic stroke.

Rationale Stroke etiology and risk factors vary by age, sex, setting (hospital or community-based) and by region. Identifying these differences would improve our understanding of stroke etiology, diagnosis, and treatment. Aim The Age, Sex and Setting in the Etiology of Stroke Study (ASSESS) is a multicenter cohort study to assess differences in stroke etiology. Methods and design Data from all centers will be categorized according to age, sex, setting, stroke subtypes. Centers with extensive hospital- or community-based data regarding stroke from Argentina, Australia, Canada, India, Iran, Italy, Ghana, Nigeria, Thailand, the United Kingdom and the United States have agreed to participate so far. Study outcomes The primary outcome includes differences in stroke etiology in study centers. The secondary outcomes include stroke incidence, risk factors, preventive strategies, and short- and long-term outcomes. Conclusion ASSESS will enable comparisons of data from different regions to determine the age and sex distribution of the most common causes of stroke in each setting. This will help clinicians to tailor the assessment and treatment of stroke patients on the basis of their specific local characteristics. It will also empower stroke epidemiologists to design preventive measures by targeting the specific characteristics of each population.

Background: Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries. Methods: Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient’s neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity. Results: Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6–7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2–3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97–6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3–28.4; p = 0.02). Conclusion: A comprehensive stroke strategy should also address socioeconomic disadvantages.

To study and analyze the dynamics of stroke morbidity and mortality rates among men and women in the territories included in the Federal program for the reorganization of care for stroke patients.The study was based on data from the territorial-population register of strokes. The study included the following territories: Ivanovo region, Stavropol territory, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. Research period was from 2009 to 2016. A total of 29 779 stroke cases were analyzed. The age of the examined people was 25 years and older.In the study areas, a 2.2 - fold decrease in stroke mortality among men and a 3-fold decrease among women was found. The values of morbidity and mortality from stroke over the entire study period were higher among men. It was also revealed that in 2015-2016, the mortality rate was in a narrow range of values, which demonstrates the impact of comprehensive measures to reduce stroke mortality in all the studied territories. The results of cluster analysis of stroke incidence rates obtained from seven territories over an 8-year period indicate similar measures for primary stroke prevention among men. Among women, there are also similarities in primary stroke prevention measures, with the exception of two regions - the Stavropol territory (4.8 cases per 1000 population) and the Republic of Tatarstan (4.5 cases per 1000 population), where the highest values of the stroke incidence rate were found. The results of cluster analysis of stroke mortality rates among men indicate a fairly large variation in the indicator values. The dominant value of the stroke mortality rate among men was found in the Sakhalin region (1.61 per 1000 population). The significance of stroke mortality rates among women in the regions was similar: six territories with similar levels of values were identified. The exception was the Stavropol territory (2.48 cases per 1000 population), where the highest death rate from stroke was revealed.Изучить динамику показателей заболеваемости инсультом и смертности от него среди лиц мужского и женского пола на территориях, вошедших в Федеральную программу реорганизации помощи пациентам с инсультом.Основой исследования стали данные территориально-популяционного регистра инсультов. В исследование были включены следующие территории: Ивановская область, Ставропольский край, Республика Башкортостан, Свердловская область, Иркутская область, Сахалинская область и Республика Татарстан. Период исследования — с 2009 по 2016 г. Проанализировано 29 779 случаев инсульта. Возраст обследуемых — 25 лет и старше.На исследуемых территориях установлено снижение показателя смертности от инсульта среди лиц мужского пола в 2,2 раза, среди лиц женского пола — в 3,0 раза. Значения показателей заболеваемости инсультом и смертности от него за весь период исследования были выше среди лиц мужского пола. Также выявлено, что за 2015—2016 гг. значения показателя смертности находились в узком диапазоне, что демонстрирует влияние комплексных мероприятий по снижению смертности от инсульта на всех изучаемых территориях. Результаты кластерного анализа значений показателя заболеваемости инсультом, полученных с семи территорий за восьмилетний период, свидетельствуют о схожих мероприятиях по первичной профилактике инсульта среди лиц мужского пола. Среди лиц женского пола также имеются сходства мероприятий по первичной профилактике инсульта, за исключением двух регионов — Ставропольского края (4,8 случая на 1000 населения) и Республики Татарстан (4,5 случая на 1000 населения), где выявлены самые высокие значения показателя заболеваемости инсультом. Результаты кластерного анализа показателя смертности от инсульта среди лиц мужского пола свидетельствуют о достаточно большом разбросе его значений. Доминантное значение показателя смертности от инсульта среди лиц мужского пола выявлено в Сахалинской области (1,61 случая на 1000 населения). Значения показателя смертности от инсульта среди лиц женского пола в регионах имеют схожий характер: выявлено шесть территорий со схожим уровнем значений, исключением стал Ставропольский край (2,48 случая на 1000 населения), где выявлено самое высокое значение показателя смертности от инсульта.

Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) comprises approximately 15% to 20% of all stroke. ICH has a mortality of approximately 40% within the first month, and 75% mortality and morbidity rate within the first year. Despite reduction in overall stroke incidence, hemorrhagic stroke incidence has remained steady since 1980. Neuroimaging is critical in detection of ICH, determining the underlying cause, identification of patients at risk of hematoma expansion, and directing the treatment strategy. This article discusses the neuroimaging methods of ICH, imaging markers for clinical outcome prediction, and future research directions with attention to the latest evidence-based guidelines.

Background and Objective:Stroke is the second leading cause of mortality and the third leading cause of morbidity worldwide. This study aimed to examine the spatial-temporal distribution of stroke in rural districts, Zanjan Province, Iran. Materials and Methods:This cross-sectional study was conducted at Zanjan University of Medical Sciences (ZUMS). Patients with a discharge diagnosis of stroke (the ICD-10 code of I64), hospitalized during 2012-2019 at ZUMS hospitals, were selected as the study sample. Spatial statistical tools, autocorrelation Moran’s I, high-low clustering analysis, and hot spot analysis were used for spatial data analysis. ArcGIS 10.7, R 3.6.0, and RStudio 1.2.1335 software packages were used to analyze the data. Results:During 2012-2019, 8404 stroke cases were hospitalized at ZUMS hospitals, with an incidence of 697 patients per 100 000 people. Men had a higher rate of stroke incidence (52.06%) compared with women (47.94%). The mean age of patients was 69.3±14.7 years; the mean length of stay was 158.8±270 hours. In the study area, 4 significantly hot spot areas and 4 low-high outliers of stroke were found. Conclusion:This study showed a high incidence of stroke in Zanjan Province, Iran, from 2012 to 2019. Identifying high-risk areas of stroke is a warning to healthcare authorities and policymakers to focus on major risk factors. It can help to figure out the possible causes of stroke and implement prevention programs to reduce stroke incidence in these areas. Keywords:Cardiovascular diseases,Epidemiology,Geographic information systems,Stroke