Carandang Raphael, Seshadri Sudha, Beiser Alexa, Kelly-Hayes Margaret, Kase Carlos S, Kannel William B, Wolf Philip A
Department of Neurology, School of Medicine, Boston University, Boston, Mass 02118-2526, USA.
JAMA. 2006 Dec 27;296(24):2939-46. doi: 10.1001/jama.296.24.2939.
Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported.
To determine long-term trends in the incidence, lifetime risk, severity, and 30-day mortality of clinical stroke.
DESIGN, SETTING, AND PARTICIPANTS: Prospective evaluation of the community-based Framingham Study original and offspring cohorts. Participants were 9152 men and women free of prevalent stroke and undergoing follow-up for up to 50 years over 3 consecutive periods (1950-1977, 1978-1989, and 1990-2004), with biennial ascertainment of stroke risk factor data and active surveillance for incident clinical stroke and cause-specific mortality.
Incidence (age-adjusted, sex-specific), severity, 30-day mortality, and mortality-adjusted 10-year and lifetime risk of stroke in each of the specified periods.
There were 1030 incident clinical strokes (450 [44%] in men, 629 atherothrombotic brain infarctions [61%]) in 9152 persons 55 years or older over 174,917 person-years of follow-up. The age-adjusted incidence of first stroke per 1000 person-years in each of the 3 periods was 7.6, 6.2, and 5.3, respectively, in men (P = .02 for trend) and 6.2, 5.8, and 5.1 in women (P = .01 for trend). The lifetime risk at age 65 years decreased from 19.5% to 14.5% in men (P = .11) and from 18.0% to 16.1% in women (P = .61). Age-adjusted stroke severity did not vary across periods; however, 30-day mortality decreased significantly in men (from 23% to 14%; P = .01) but not significantly in women (from 21% to 20%; P = .32).
In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts.
先前对中风发病率和严重程度的长期趋势估计各不相同；终生风险趋势尚未见报道。
确定临床中风的发病率、终生风险、严重程度和30天死亡率的长期趋势。
设计、地点和参与者：对基于社区的弗雷明汉心脏研究原始队列和后代队列进行前瞻性评估。参与者为9152名男性和女性，无中风病史，在连续3个时期（1950 - 1977年、1978 - 1989年和1990 - 2004年）接受长达50年的随访，每两年确定一次中风危险因素数据，并对临床中风事件和特定病因死亡率进行主动监测。
各指定时期中风的发病率（年龄调整、性别特异）、严重程度、30天死亡率以及死亡率调整后的10年和终生风险。
在9152名55岁及以上的人群中，经过174,917人年的随访，发生了1030例临床中风事件（男性450例[44%]，629例动脉粥样硬化性脑梗死[61%]）。在这3个时期中，男性每1000人年首次中风的年龄调整发病率分别为7.6、6.2和5.3（趋势P = 0.02），女性分别为6.2、5.8和5.1（趋势P = 0.01）。65岁时的终生风险在男性中从19.5%降至14.5%（P = 0.11），在女性中从18.0%降至16.1%（P = 0.61）。年龄调整后的中风严重程度在各时期无变化；然而，男性的30天死亡率显著下降（从23%降至14%；P = 0.01），而女性则无显著下降（从21%降至20%；P = 0.32）。
在初次检查时无临床中风病史的这组男性和女性中，中风发病率在过去50年中有所下降，但终生风险并未同等程度下降，这可能归因于预期寿命的延长。本研究结果表明，对危险因素控制的改善降低了中风发病率，但强调了持续进行一级预防努力的必要性。
