From the Boston University School of Medicine, MA (H.J.A., J.J.H., C.L.S., J.R.R., C.S.K., A.S.B., S.S.).
Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio (C.L.S., S.S.).
Stroke. 2019 Jun;50(6):1558-1560. doi: 10.1161/STROKEAHA.119.025171. Epub 2019 May 14.
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 <0.001). Between epochs 1 and 4, the average 10-year risk of stroke, as estimated by the Framingham Stroke Risk Profile, declined by 0.7% at midlife and 1.1% at older age. Conclusions- Long-term rates of ischemic stroke declined in our community sample; the decline was greater in older as compared with younger adults. Early prevention, focused on modification of cardiovascular risk factors, is important to see sustained declines in stroke incidence and mortality at midlife.
背景与目的- 中年发生的中风对丧失的残疾调整生命年有不成比例的巨大影响。这个年龄段的缺血性中风发病率可能正在上升。我们在按中年和老年发病分层的社区样本中研究了缺血性中风发病率的长期趋势以及中风危险因素的变化。
方法- 在弗雷明汉研究中，自 1948 年以来一直在监测中风的发病情况。我们使用 Cox 模型，在起始随访时年龄为 35-54 岁和≥55 岁的人群中，检查了年龄和性别调整后的缺血性中风 10 年发病率。在 4 个时期进行了线性趋势检验，同时控制了间隔时间的远近。此外，我们根据弗雷明汉中风风险概况中的血管危险因素，计算了每个时期以及两个年龄组的中风 10 年平均风险。
结果- 1962 年（n=3966）、1971 年（n=5779）、1987 年（n=5133）和 1998 年（n=6964）开始的每个时期内分别有 153、197、176 和 165 例缺血性中风。中年发生的大多数缺血性中风（n=71）是由于动脉粥样硬化性脑梗死（n=50）或心源性栓塞（n=19）。以 1962 年时期的风险为参照，中年发生中风的风险并未显著下降（危险比，0.87；95%置信区间，0.74-1.02；趋势 P=0.09）。老年组的缺血性中风发病率下降（危险比，0.82；95%置信区间，0.77-0.88；趋势 P<0.001）。在 1 到 4 个时期之间，通过弗雷明汉中风风险概况估计的中风 10 年平均风险在中年下降了 0.7%，在老年下降了 1.1%。
结论- 在我们的社区样本中，缺血性中风的长期发病率下降；与年轻成年人相比，老年人群的下降幅度更大。早期预防，重点是心血管危险因素的改变，对于维持中年中风发病率和死亡率的持续下降非常重要。
