Temporal Trends in Ischemic Stroke Incidence in Younger Adults in the Framingham Study
Temporal Trends in Ischemic Stroke Incidence in Younger Adults in the Framingham Study
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DOI：
10.1161/strokeaha.119.025171
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发表时间：
2019-06-01
期刊：
影响因子：
8.3
通讯作者：
Seshadri, Sudha
中科院分区：
文献类型：
--
作者：
Aparicio, Hugo J.;Himali, Jayandra J.;Seshadri, Sudha
背景和目的中年中风对伤残调整后的寿命损失有不成比例的巨大影响。在这个年龄段，缺血性中风的发病率可能会增加。我们在一个社区样本中调查了缺血性中风发病率的长期趋势和中风危险因素的变化。方法在Framingham研究中，自1948年以来一直在监测中风事件。我们使用COX模型检验了年龄调整和性别调整后的10年缺血性中风发病率，研究对象分别为35岁至54岁和55岁的患者。线性趋势的测试是在4个时期进行的，控制了间隔之间的时间距离。结果从1962年(n=3966)、1971年(n=5779)、1987年(n=5133)和1998年(n=6964)开始，每个时期发生的缺血性中风分别为153、197、176和165例。中年缺血性卒中(n=71)多为动脉粥样硬化性脑梗塞(n=50)或心源性栓塞症(n=19)。以1962年为参照，中年发生缺血性卒中的风险并未显著下降(危险比，0.87；95%CI，0.74~1.02；P趋势=0.09)。老年组缺血性卒中发生率下降(危险比，0.82；95%可信区间，0.77-0.88；P趋势
Background and Purpose Stroke at midlife has a disproportionately large impact on disability-adjusted life-years lost. Ischemic stroke incidence may be increasing at this age. We investigated long-term trends in ischemic stroke incidence and changes in stroke risk factors in a community sample stratified by stroke onset at middle and older age.Methods In the Framingham Study, surveillance for incident stroke is ongoing since 1948. We examined age-adjusted and sex-adjusted 10-year incidence of ischemic stroke using Cox models in persons aged 35 to 54 and 55 years at start of follow-up. Tests for linear trend were performed over 4 epochs, controlling for the distance in time between intervals. Further, we calculated the mean 10-year risk of stroke at each epoch and for both age groups, based on vascular risk factors from the Framingham Stroke Risk Profile.Results There were 153, 197, 176, and 165 incident ischemic strokes within each epoch beginning in 1962 (n=3966), 1971 (n=5779), 1987 (n=5133), and 1998 (n=6964). Most ischemic strokes at midlife (n=71) were because of atherosclerotic brain infarction (n=50) or cardioembolism (n=19). Using the risk in the 1962 epoch as the reference, the risk of ischemic stroke at midlife did not significantly decline (hazard ratio, 0.87; 95% CI, 0.74-1.02; P trend =0.09). Incidence of ischemic stroke declined in the older group (hazard ratio, 0.82; 95% CI, 0.77-0.88; P trend