Background and Purpose:Declining trends in the incidence and mortality of str oke have been observed in Finland since the beginning of the 1980s until 1997. I n this study we analyzed the trends in fatal and nonfatal ...Background and Purpose:Declining trends in the incidence and mortality of str oke have been observed in Finland since the beginning of the 1980s until 1997. I n this study we analyzed the trends in fatal and nonfatal strokes in Finland dur ing 1991-2002. Methods The Finnish Hospital Discharge Register was linked to th e National Causes of Death Register to produce a Cardiovascular Disease Register , which includes data on 410760 cerebrovascular events (International Statistica l Classification of Diseases, 10th Revision [ICD-10] codes 160-169) in patient s aged ≥35 years in 1991-2002. Results:Age-standardized incidence of first- ever stroke (ICD-10 codes 160-164,excluding 163.6) per 100 000 persons decline d during 1991-2002 annually by 2.2%(95%CI, -2.4%to -1.9%) among men and 2 .5%(-2.8%to -2.2%) among women aged 35 to 74 years.In patients aged 75 to 8 4 years, the change in the incidence of first-ever stroke was -2.6%per year ( -3.0%to -2.2%) among men and -3.2%per year (-3.5%to -2.9%) among women . A similar trend was observed also in the oldest age group, in patients aged ≥ 85 years. Among patients aged 35 to 74 years,the 28-day case fatality of first -ever stroke declined annually by 3.2%(-3.9%to -2.5%) among men and by 3.0 %(-3.8%to -2.2%) among women. A significant decrease was found in the 28-d ay case fatalities of all subtypes of stroke in this age group. Conclusions:The favorable development in stroke incidence, mortality, and case-fatality has co ntinued in Finland during 1991-2002.展开更多
Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospecti...Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke(Rankin grade≤3), after 10 years or more. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial(recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis. Findings: Follow-up was complete in 2447(99%) patients. After a mean follow-up of 10.1 years, 1489(60%) patients had died and 1336(54%) had had at least one vascular event. 10-year risk of death was 42.7%(95%CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33(2.97-3.73) for age over 65 years, 2.10(1.79-2.48) for diabetes, 1.77(1.45-2.15) for claudication, 1.94(1.42-2.65) for previous peripheral vascular surgery, and 1.50(1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1%(42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death. Interpretation: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.展开更多
This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral ste...This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis. Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated. We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age >60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism. Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate-(hazard ratio0.33 [95%confidence interval(CI)0.12 to 0.91]; p=0.02) and the high-risk group(HR 0.51[95%CI 0.27 to 0.96]; p=0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy. The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients.展开更多
EMPA-REG OUTCOME研究结果于9月17日在第51届欧洲糖尿病研究学会年会上公布并同时发表在New England Journal of Medicine杂志。结果表明,治疗心血管事件风险较高的2型糖尿病患者时,标准治疗方案基础上追加勃林格殷格翰和礼来公司的Jard...EMPA-REG OUTCOME研究结果于9月17日在第51届欧洲糖尿病研究学会年会上公布并同时发表在New England Journal of Medicine杂志。结果表明,治疗心血管事件风险较高的2型糖尿病患者时,标准治疗方案基础上追加勃林格殷格翰和礼来公司的Jardiance®(恩格列净)显著降低由心血管死亡、非致死性心梗、非致死性脑卒中组成的复合终点的风险达14%。其中心血管死亡降低38%,非致死性心梗、展开更多
文摘Background and Purpose:Declining trends in the incidence and mortality of str oke have been observed in Finland since the beginning of the 1980s until 1997. I n this study we analyzed the trends in fatal and nonfatal strokes in Finland dur ing 1991-2002. Methods The Finnish Hospital Discharge Register was linked to th e National Causes of Death Register to produce a Cardiovascular Disease Register , which includes data on 410760 cerebrovascular events (International Statistica l Classification of Diseases, 10th Revision [ICD-10] codes 160-169) in patient s aged ≥35 years in 1991-2002. Results:Age-standardized incidence of first- ever stroke (ICD-10 codes 160-164,excluding 163.6) per 100 000 persons decline d during 1991-2002 annually by 2.2%(95%CI, -2.4%to -1.9%) among men and 2 .5%(-2.8%to -2.2%) among women aged 35 to 74 years.In patients aged 75 to 8 4 years, the change in the incidence of first-ever stroke was -2.6%per year ( -3.0%to -2.2%) among men and -3.2%per year (-3.5%to -2.9%) among women . A similar trend was observed also in the oldest age group, in patients aged ≥ 85 years. Among patients aged 35 to 74 years,the 28-day case fatality of first -ever stroke declined annually by 3.2%(-3.9%to -2.5%) among men and by 3.0 %(-3.8%to -2.2%) among women. A significant decrease was found in the 28-d ay case fatalities of all subtypes of stroke in this age group. Conclusions:The favorable development in stroke incidence, mortality, and case-fatality has co ntinued in Finland during 1991-2002.
文摘Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke(Rankin grade≤3), after 10 years or more. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial(recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis. Findings: Follow-up was complete in 2447(99%) patients. After a mean follow-up of 10.1 years, 1489(60%) patients had died and 1336(54%) had had at least one vascular event. 10-year risk of death was 42.7%(95%CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33(2.97-3.73) for age over 65 years, 2.10(1.79-2.48) for diabetes, 1.77(1.45-2.15) for claudication, 1.94(1.42-2.65) for previous peripheral vascular surgery, and 1.50(1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1%(42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death. Interpretation: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.
文摘This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis. Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated. We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age >60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism. Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate-(hazard ratio0.33 [95%confidence interval(CI)0.12 to 0.91]; p=0.02) and the high-risk group(HR 0.51[95%CI 0.27 to 0.96]; p=0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy. The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients.
文摘EMPA-REG OUTCOME研究结果于9月17日在第51届欧洲糖尿病研究学会年会上公布并同时发表在New England Journal of Medicine杂志。结果表明,治疗心血管事件风险较高的2型糖尿病患者时,标准治疗方案基础上追加勃林格殷格翰和礼来公司的Jardiance®(恩格列净)显著降低由心血管死亡、非致死性心梗、非致死性脑卒中组成的复合终点的风险达14%。其中心血管死亡降低38%,非致死性心梗、
