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Incidence of intracerebral haemorrhage over the past three decades is reported as stable. This disappointing finding is questionable and suggests that any reduction in intracerebral haemorrhage incidence associated with improvements in primary prevention, namely, better control of blood pressure, might have been offset by an increase in cases of intracerebral haemorrhage owing to other factors, including the use of antithrombotic drugs in the ageing population. Therefore, we aimed to analyse trends in intracerebral haemorrhage incidence from 1985 to 2008 in the population-based registry of Dijon, France, taking into consideration the intracerebral haemorrhage location, the effect of age and the changes in the distribution of risk factors and premorbid treatments. Incidence rates were calculated and temporal trends were analysed by age groups (<60, 60–74 and &geq;75 years) and intracerebral haemorrhage location (lobar or deep) according to study periods 1985–92, 1993–2000 and 2001–08. Over the 24 years of the study, 3948 patients with first-ever stroke were recorded. Among these, 441 had intracerebral haemorrhage (48.3% male), including 49% lobar, 37% deep, 9% infratentorial and 5% of undetermined location. Mean age at onset increased from 67.3 ± 15.9 years to 74.7 ± 16.7 years over the study period (P < 0.001). Overall crude incidence was 12.4/100 000/year (95% confidence interval: 11.2–13.6) and remained stable over time. However, an ∼80% increase in intracerebral haemorrhage incidence among people aged &geq;75 years was observed between the first and both second and third study periods, contrasting with a 50% decrease in that in individuals aged <60 years, and stable incidence in those aged 60–74 years. This result was attributed to a 2-fold increase in lobar intracerebral haemorrhage in the elderly, concomitantly with an observed rise in the premorbid use of antithrombotics at this age, whatever the intracerebral haemorrhage location considered. In conclusion, intracerebral haemorrhage profiles have changed in the past 20 years, suggesting that some bleeding-prone vasculopathies in the elderly are more likely to bleed when antithrombotic drugs are used, as illustrated by the rise in the incidence of lobar intracerebral haemorrhage in the elderly, in which cerebral amyloid angiopathy may be strongly implicated. Future research should focus on the impact and management of antithrombotics in patients with intracerebral haemorrhage, which may differ according to the underlying vessel disease. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to estimate trends in stroke case fatality in a French population-based study over the last 20 years, and to compare trends in men and women. Methods: We prospectively ascertained first-ever strokes in a well-defined population-based study, from 1985 to 2004, in Dijon (France) (150,000 inhabitants). The study was both specific and exhaustive. The follow-up made it possible to analyze case fatality, according to stroke subtypes and sex. Results: From the ascertainment of 3,691 strokes divided in 1,920 cerebral infarcts from large artery atheroma, 725 cerebral infarcts from small perforating artery atheroma, 497 cardioembolic infarcts, 134 cerebral infarcts from undetermined mechanism, 341 primary cerebral hemorrhages and 74 subarachnoïd hemorrhages, we observed a significant decrease in 28-day case fatality rates of almost 25% (p = 0.03). Case fatality rates decreased in men aged >75 years (p = 0.01) and in women aged >75 years (p = 0.02) and >65 years (p = 0.03). The magnitude of the decrease was smaller in women but not significantly so. According to stroke subtypes, case fatality rates significantly decreased for small perforating artery infarct (p = 0.04) and for primary cerebral hemorrhage (p = 0.03). In multivariate regression analyses, hemorrhagic stroke, the first period of the study (1985–1989), blood hypertension, previous myocardial infarction and age <85 years had a negative effect. Conclusion: This is the first population-based study using continuous ascertainment over a period of 20 years that has demonstrated a significant reduction in case fatality rates. We did not observe any significant differences between men and women. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: We describe the epidemiological trends of transient ischemic attack (TIA) in a 20-year population-based pilot study. Methods: Trends in the incidence, risk factors and pre-TIA use of preventive treatments for TIA were observed from 1985 to 2004 according to the classic definition in the population of the city of Dijon, France (150,000 inhabitants). Results: The raw and standardized incidence of TIA were stable over time. We observed a significant increase in the mean age at TIA onset in women only. The prevalence of hypercholesterolemia and diastolic blood pressure ≥90 mm Hg among patients with TIA increased significantly. This contrasts with falls in smoking and in history of previous myocardial infarction. Conclusion: The stability of classic TIA incidence, despite the rise in the proportion of elderly people, and the increase in the mean age at onset in women may be considered as a medical progress. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]