Stroke subtypes and comorbidity among ischemic stroke patients in Brasilia and Cuenca: a Brazilian-Spanish cross-cultural study.
BACKGROUND
With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain.


METHODS
This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity.


RESULTS
A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005).


CONCLUSIONS
Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population.
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain; Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: fjcarod-artal@hotmail.com.
Francisco Javier
FJ
Carod-Artal
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Jardiel Omar
JO
Casanova Lanchipa
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Luis Miguel
LM
Cruz Ramírez
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Noelia Sánchez
NS
Pérez
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Fátima M
FM
Siacara Aguayo
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Isabel Gómez
IG
Moreno
Neurology Department, Virgen de la Luz Hospital, Cuenca, Spain.
Lourdes Gómez
LG
Romero
Neurology Department, Sarah Hospital, Brasilia DF, Brazil.
Luciene Ferreira
LF
Coral
Neurology Department, Sarah Hospital, Brasilia DF, Brazil.
Daniele Stieven
DS
Trizotto
Neurology Department, Sarah Hospital, Brasilia DF, Brazil.
Clarissa Menezes
CM
Moreira
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000150:complications* / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020127:Recovery of Function; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
Atrial fibrillation; cross-cultural; elderly; health care disparities; stroke; stroke subtypes