Jérôme Durier

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.

Stroke associated with giant cell arteritis: a population-based study

Background Giant cell arteritis (GCA) is the most common vasculitis in people ≥50 years and can be associated with stroke. We aimed to evaluate the epidemiology and characteristics of stroke in patients with GCA. Methods All patients with a biopsy-proven diagnosis of GCA were identified among residents of the city of Dijon, France (152 000 inhabitants), between 2001 and 2012 using a prospective database. Among these, patients who suffered from stroke were retrieved by crossing data from the population-based Dijon Stroke Registry. Demographics and clinical features were recorded. We considered that the stroke was GCA-related if the stroke revealed GCA or occurred between the onset of symptoms and 4 weeks after the start of treatment. Results Among the 57 biopsy-proven patients with GCA (incidence rate 10.9/100 000/year in individuals ≥50 years), 4 (7.0%) experienced a GCA-related stroke. Three were men and all had ≥2 vascular risk factors and were ≥80 years. The stroke was vertebrobasilar for 3/4 patients and undetermined for the remaining one. The incidence rate of GCA-related stroke in patients ≥50 years was 0.76/100 000/year (95% CI 0 to 2.47), 1.36/100 000/year in men (95% CI 0 to 3.63) and 0.33/100 000/year (95% CI 0 to 1.45) in women. Conclusions This population-based study demonstrated that GCA-related stroke essentially affects the vertebrobasilar territory and mainly occurs in old men with associated vascular risk factors. Although rare, GCA symptoms must be searched for in elderly patients with stroke, and optimal vascular prevention must be conducted carefully in patients with GCA with a high vascular risk before initiating GCA treatment.

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.

Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry

Background Reliable epidemiological data on the true incidence of cerebrovascular events related to spontaneous cervical artery dissection, including stroke and transient ischemic attack, are scarce. Aims To evaluate the incidence, characteristics, and outcome of cerebrovascular events due to cervical artery dissection. Methods All cerebrovascular events (stroke and transient ischemic attack) occurring in Dijon, France, from 2006 to 2011, were retrieved from a population-based registry. Patients with a cervical artery dissection were identified. Incidence rates, baseline characteristics, and outcome at three-months were described. Results Among the 1368 patients with cerebrovascular events, 27 had cervical artery dissection (2·0%, 52% men, mean age 49·1 ± 17·1), including 10 patients with internal carotid artery dissection, 16 patients with vertebral artery dissection, and one patients with both internal carotid artery dissection and vertebral artery dissection. The crude incidence rate of cerebrovascular events due to cervical artery dissection was 2·97/100 000/ year. Corresponding rates were 1·21/100 000/year for internal carotid artery dissection, and 1·87/100 000/year for vertebral artery dissection. Seventy per cent of patients had a stroke and among these, higher severity was observed in those with internal carotid artery dissection. A good outcome (m-Rankin score 0–2) was observed in 89% of patients at three-months, whatever the location of the cervical artery dissection. One patient with vertebral artery dissection died at day 38. Conclusion The incidence of cerebrovascular events related to vertebral artery dissection is greater than previously reported, which may indicate a better identification of patients due to improvements in diagnostic procedures.

Epidemiology of stroke in Europe and trends for the 21st century

Despite major improvements in primary prevention and acute treatment over the last decades, stroke is still a devastating disease. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290/100,000 per year, with one-month case-fatality rates ranging from 13 to 35%. Approximately 1.1 million inhabitants of Europe suffered a stroke each year, and ischemic stroke accounted for approximately 80% of cases. Although global stroke incidence is declining, rates observed in young adults are on the rise, thus suggesting a need for strategies to improve prevention. In addition, because of the ageing population, the absolute number of stroke is expected to dramatically increase in coming years: by 2025, 1.5 million European people will suffer a stroke each year. Beyond vital prognosis, stroke patients are also at increased risk of poor outcome within the first year of the event including re-hospitalisation (33%), recurrent event (7 to 13%), dementia (7 to 23%) mild cognitive disorder (35 to 47%), depression (30 to 50%), and fatigue (35% to 92%), all of them contributing to affect health related quality of life. Given these observations, an urgent development of acute care provision, as well as resources for post-stroke therapeutic strategies, is needed.

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.

Prevalence and prognostic value of headache on early mortality in acute stroke: the Dijon Stroke Registry.

Objective To evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients. Methods All patients with stroke in Dijon, France (2006–2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality. Results Among 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, p < 0.001). Overall 30-day mortality was 11.7%, and was greater for patients with than those without headache (17.0% vs 10.5%, unadjusted HR 1.70; 95% CI 1.20–2.41, p = 0.003). In multivariable analysis, an association between headache and 30-day mortality was observed (HR 1.51; 95% CI 1.02–2.25, p = 0.042). In stratified analyses, headache was associated with 30-day mortality in ICH (HR 2.09; 95% CI 1.18–3.71, p = 0.011) but not in IS (HR 1.01; 95% CI 0.53–1.92, p = 0.97). Conclusion Headache at stroke onset is associated with a higher risk of early mortality in patients with ICH.

One‐year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985–2008)

Background and purpose:  Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post‐stroke dementia was a predictor of 1‐year case‐fatality and to evaluate factors that could influence survival in demented stroke patients.

iScore for Predicting Institutional Care after Ischemic Stroke: A Population-Based Study

BACKGROUND We assessed whether the iScore could predict the need for poststroke institutional care. METHODS Patients with acute ischemic stroke living in Dijon, France, were recorded between 2006 and 2011, using a population-based stroke registry. The iScore was calculated for each patient. A logistic regression model was used to assess the performance of the iScore for predicting the need for placement in a care institution. The discrimination and calibration of the model were assessed using the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS Of the 1199 patients recorded, 124 were excluded because of early death and 95 because of missing for variables included in the iScore. Of the remaining 980 patients, 522 (53.3%) returned home and 458 (46.7%) required placement in a care institution. The median iScore was 123 (interquartile range, 97-148), and the proportion of patients who required placement in a care institution increased with each quintile of risk score. The discrimination of the model was good with a c statistic of .75 (95% confidence interval, .72-.78), as was calibration (P = .35). CONCLUSIONS The iScore could be useful for predicting the need for placement in a care institution in ischemic stroke patients. Further studies are required to confirm this finding.