Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases

• Published in: Neurología (Barcelona, English ed. )
• Main Authors: Sánchez-Larsen, Á, García-García, J, Ayo-Martín, O, Hernández-Fernández, F, Díaz-Maroto, I, Fernández-Díaz, E, Monteagudo, M, Segura, T
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.07.2018
• Subjects: Etiología del ictus; TOAST; Stroke Data Bank; Stroke aetiology; Atrial fibrillation; Base de Datos de Ictus; Stroke subtypes; Factores de riesgo vascular; Subtipos de ictus; Fibrilación auricular; Vascular risk factors
• DOI: 10.1016/j.nrl.2016.07.003

We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide. Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.