Stroke first
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Incidence and Prevention of First-Ever Stroke
Incidence of First-Ever Stroke
Nationwide Inpatient Sample Analysis
A comprehensive study using the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project estimated that there were approximately 750,000 first-ever or recurrent strokes in the United States during 1995. This figure includes 682,000 hospitalizations and an estimated 68,000 occurrences without hospitalization. The overall incidence rate for total stroke (first-ever and recurrent) was 259 per 100,000 population, with rates increasing exponentially with age and being consistently higher for males than females.
Oxfordshire Community Stroke Project
The Oxfordshire Community Stroke Project, which monitored a community of about 105,000 people, registered 675 cases of first-ever stroke over four years. This yielded a crude annual incidence of 1.60 per 1,000, or 2.00 per 1,000 when adjusted to the 1981 population of England and Wales. The study found that the incidence rates for first stroke increased steeply with age for both sexes, with males having a 26% greater risk than females.
Greater Cincinnati/Northern Kentucky Stroke Study
In the Greater Cincinnati/Northern Kentucky Stroke Study, the incidence rate for first-ever hospitalized or autopsied stroke among blacks was 288 per 100,000, while the rate for first-ever and recurrent stroke was 411 per 100,000. These rates were significantly higher than those observed among whites in Rochester, Minnesota, during the same period, highlighting racial disparities in stroke incidence.
Long-Term Survival After First-Ever Stroke
Perth Community Stroke Study
The Perth Community Stroke Study followed 251 patients with first-ever stroke over ten years. By the end of the study, 79% of the patients had died, with the major causes of death being the direct effects of the initial stroke and cardiovascular disease. The average annual case fatality among one-year survivors was 4.8%, which was more than twice that expected for the general population of the same age and sex.
Primary Prevention of First-Ever Stroke
American Heart Association/American Stroke Association Guidelines
The American Heart Association (AHA) and American Stroke Association (ASA) have provided extensive guidelines for the primary prevention of stroke. These guidelines classify risk factors into nonmodifiable (e.g., age, sex, race/ethnicity, genetic predisposition) and modifiable categories (e.g., hypertension, diabetes, smoking, physical inactivity). Well-documented modifiable risk factors include hypertension, diabetes, atrial fibrillation, dyslipidemia, and lifestyle factors such as diet and physical activity. The guidelines emphasize the importance of managing these risk factors to reduce the risk of a first stroke .
National Stroke Association Consensus
The National Stroke Association's consensus statement highlights several interventions that can reduce the risk of a first stroke. These include treating hypertension, using warfarin for patients with atrial fibrillation or after myocardial infarction, and performing carotid endarterectomy for patients with significant carotid artery stenosis. The statement also underscores the role of lifestyle modifications, such as smoking cessation, reducing alcohol consumption, increasing physical activity, and improving diet.
Conclusion
The incidence of first-ever stroke varies significantly across different populations and is influenced by a range of modifiable and nonmodifiable risk factors. Long-term survival after a first stroke is generally poor, with a high risk of mortality due to the initial stroke and subsequent cardiovascular events. Preventive measures, including the management of hypertension, diabetes, and lifestyle factors, are crucial in reducing the risk of a first stroke. Comprehensive guidelines from organizations like the AHA and ASA provide valuable strategies for primary prevention, emphasizing the importance of addressing both well-documented and potentially modifiable risk factors.
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