Guy-Victor Osseby

Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry

Background Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged <55 years old had changed over the last three decades. Methods All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed. Results Over the 27-year study period, 4506 patients were recorded (53% women, mean age 74.6±14.4, 10.1% aged <55 years). An increase in overall stroke incidence was noted, as was a rise in ischaemic stroke in individuals aged <55 years (IRR 1.308; 95% CI 0.982 to 1.741, p=0.066 for period 1994–2002 vs period 1985–1993, and IRR 1.697; 95% CI 1.340 to 2.150, p<0.001 for period 2003–2011 vs period 1994–2002), which was consistent for men and women. In these young patients, smoking was the most frequent risk factor (43%). Conclusions Multiple factors may account for the increased incidence of ischaemic stroke in people aged <55 years including changes in vascular risk factors, better awareness of the disease and treatment options in the population and among practitioners leading to more frequent referrals for specialised care, and improvements in stroke diagnosis. Stroke prevention must be encouraged even in young adults.

Trends in Incidence, Risk Factors, and Survival in Symptomatic Lacunar Stroke in Dijon, France, From 1989 to 2006 A Population-Based Study

Background and Purpose— Lacunar infarcts are usually regarded as benign stroke, but population-based studies are required to assess the exact place of this stroke subtype in cerebrovascular pathology. Methods— We evaluated trends in incidence rates, risk factor profiles, and survival rates in symptomatic lacunar stroke from a prospective population-based registry from 1989 to 2006. Results— We recorded 2536 ischemic strokes. Among these, 715 (28%) were lacunar infarcts (354 men and 361 women). From 1989 to 2006, we observed a significant rise in the incidence of lacunar stroke in the 2 sexes considered together (relative risk, 1.02; 95% CI, 1.005 to 1.035; P=0.007), whereas the variation was not significant in either men or women when considered separately. Incidence rates significantly increased in young patients under 65 years old (relative risk, 1.049; 95% CI, 1.0175 to 1.0817; P=0.002). Concerning the distribution of cerebrovascular risk factors, lacunar stroke differed from nonlacunar stroke only with regard to the lower prevalence of a history of atrial fibrillation in the former (P<0.001). For lacunar infarcts, survival rates were 96% at 1 month (95% CI, 0.94 to 0.97), 86% at 1 year (95% CI, 0.83 to 0.89), and 78% at 2 years (95% CI, 0.75 to 0.81) and were significantly higher than those for nonlacunar stroke (hazard ratio, 2.05; 95% CI, 1.70 to 2.47; P<0.001). Conclusion— Our results suggest a significant increase in the incidence rates of lacunar stroke with a relatively good short-term prognosis in terms of survival. The association among hypertension, diabetes mellitus, and lacunar stroke was no stronger than the association between these 2 risk factors and nonlacunar stroke.

Serum 25-hydroxyvitamin D predicts severity and prognosis in stroke patients.

We aimed to evaluate the association between 25‐hydroxyvitamin D (25(OH)D) levels and both clinical severity at admission and outcome at discharge in stroke patients.

Post-Stroke Cognitive Impairment: High Prevalence and Determining Factors in a Cohort of Mild Stroke

BACKGROUND Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing. OBJECTIVE To identify the factors associated with 3-month PSCI. METHODS All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010 - February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MOCA). Patients assessable at 3 months were categorized as cognitively impaired if the MMSE score was ≤26/30 and MOCA <26/30 or if the neuropsychological battery confirmed PSCI when the MMSE and MOCA were discordant. Multivariable logistic models were used to determine factors associated with 3-month PSCI. RESULTS Among the 280 patients included, 220 were assessable at 3 months. The overall frequency of 3-month PSCI was 47.3%, whereas that of dementia was 7.7%. In multivariable analyses, 3-month PSCI was associated with age, low education level, a history of diabetes mellitus, acute confusion, silent infarcts, and functional handicap at discharge. MMSE and MOCA scores during hospitalization were associated with 3-month PSCI (OR = 0.63; 95% CI: 0.54-0.74; p < 0.0001 and OR = 0.67; 95% CI: 0.59-0.76; p < 0.0001, respectively). CONCLUSION Our study underlines the high frequency of PSCI in a cohort of mild stroke. The early cognitive diagnosis of stroke patients could be useful by helping physicians to identify those at a high risk of developing PSCI.

Dijon’s vanishing lead with regard to low incidence of stroke

Background:  Towards the end of the 20th century, the city of Dijon, France, had a lower incidence of stroke than that found in other studies. It was hypothesized that genetic and environmental factors were responsible for this so‐called French paradox. We aim to evaluate recent changes in stroke incidence to determine whether or not the Dijon exception still exists.

Stroke care organization overcomes the deleterious ‘weekend effect’ on 1-month stroke mortality: a population-based study

Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30‐day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated.

Changes in risk factors and preventive treatments by stroke subtypes over 20 years: A population-based study

In order to evaluate progress in preventive therapeutic strategies, and to identify potential targets for improvement, it is essential to assess changes in the risk factors and preventive treatment of stroke over time. All of the strokes occurring within the population of Dijon, France (150,000 inhabitants), were prospectively ascertained from 1985 to 2004. Changes in stroke risk factors and preventive medications were analyzed by stroke subtypes. We recorded 725 lacunar infarcts (LI), 497 cardioembolic (CE) strokes, 2054 ischemic stroke from atheroma of large arteries or from other and undetermined causes (OIS), and 341 primary cerebral haemorrhages (PCH). Over the 20years, the prevalence of hypercholesterolemia increased whatever the stroke subtype (p<0.01) whereas that of diabetes only rose in LI and OIS stroke. The proportion of stroke patients on antiplatelet agents increased overall (p<0.01) and the proportion of patients on anticoagulants rose in CE stroke (p=0.01) and PCH (p<0.01). The proportion of patients on antihypertensive treatment only increased in CE stroke (p=0.01). The risk factor profile and the preventive treatments in stroke patients showed divergent variations over the 20years, according to the stroke subtype considered. These modifications certainly reflect changes in the therapeutic strategies for the preventive management of the population at risk.

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Background: Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI). Methods: All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups. Results: Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p<0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in women <65 years and 2.32 (95% CI 1.95 to 2.75; p<0.001) in those >65 years whereas it was 0.60 (95% CI 0.42 to 0.86; p<0.001) in men below 55 years, 1.01 (0.81 to 1.24, p = 0.96) in those between 55 and 75 years and 2.01 (95% CI 1.48 to 2.71; p<0.001) at 75 years and older. CFRs at 30 days were similar for stroke and AMI (9.80% vs 9.84%; p = 0.5). Hyperglycaemia (>7.8 mmol/l) at onset was significantly associated with higher CFR in both stroke and AMI patients. The prevalence of male sex, hypercholesterolaemia and diabetes was higher in AMI patients whereas hypertension was more frequent in stroke patients. Conclusion: These findings will help health care authorities to evaluate future needs for stroke and AMI services, and to develop secondary prevention strategies.

Variation saisonniere des accidents vasculaires cérébraux et influence des conditions météorologiques

Resume Le but de cette etude etait d’analyser la repartition saisonniere et mensuelle des differents sous-types d’accidents vasculaires cerebraux (AVC), ainsi que l’influence des parametres meteorologiques conventionnels sur leur survenue. L’etude, fondee sur les donnees de population du registre des AVC de la ville de Dijon, a inclus 3 287 patients ayant eu un accident vasculaire cerebral au cours des annees 1985 a 1998. La repartition saisonniere a mis en evidence une baisse estivale pour tous les sous-types d’AVC, la difference entre les saisons etant significative pour l’infarctus cerebral, l’infarctus cardioembolique et l’infarctus atherothrombotique des grosses arteres, ainsi que pour le total des AVC. L’automne et le printemps furent les saisons a plus haut risque cerebrovasculaire, avec un pic significatif en octobre pour l’infarctus cerebral. Les correlations avec les donnees meteorologiques ont montre une influence de la temperature, de l’humidite relative, de la vitesse du vent, de l’insolation ou de la neige sur certains sous-types d’AVC. Ces resultats different parfois de ceux d’etudes anterieures realisees sous d’autres climats et en presence d’autres facteurs de risque, ce qui souligne la necessite de proceder a des etudes epidemiologiques regionales si l’on veut determiner les relations entre saisons, facteurs meteorologiques et AVC.

Les accidents vasculaires cérébraux : ce qui a changé au début du xxie siècle

INTRODUCTION Striking developments in stroke epidemiology, initially based on the results of the Framingham study, have greatly improved our neuroepidemiological knowledge of the disease. STATE OF ART The development of stroke registries has made it possible to evaluate the descriptive epidemiology of stroke and its evolution. With the increasing use of CT-scan, MRI, and either cardiac or vascular imaging, the diagnosis of stroke and its subtypes has been made easier. Over the last 20 years, a decrease in the incidence and mortality of stroke has been observed in Western countries. In contrast, in Dijon, which has the only population-based stroke registry in France, stable incidence rates have been reported. However, over the same period, age at stroke onset has risen by five years in men and eight years in women, which is probably related to both population aging and improvements in primary prevention and general health. The reported decrease in case-fatality rates suggests better acute management of stroke patients, and explains in part the increase in the prevalence of stroke. In addition, the assessment of vascular risk factors has demonstrated that high blood pressure remains the principal risk factor for both ischemic and hemorrhagic stroke, and that antihypertensive treatment is able to reduce stroke incidence. PERSPECTIVES Epidemiology studies could make it possible to measure the impact of new therapeutic strategies applied in both primary and secondary prevention. CONCLUSION Prevention, diagnosis, and acute treatment of stroke have considerably improved, but cerebrovascular diseases together with myocardial infarction remain the leading cause of death. Despite the absence of a rise in the incidence of stroke, its prevalence has increased. This is due to the decrease in case-fatality rates. As a consequence, there is an urgent need to organize health networks around stroke. Moreover, the rise in stroke-free life expectancy is a positive finding that reflects improvements in prevention.