title: Secular trends in ischemic stroke subtypes and stroke risk factors.
abstract: OBJECTIVE
  Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins.
  
  
  METHODS
  We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012.
  
  
  RESULTS
  There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (P<0.05 for trend). Trends remained significant after adjusting for population change.
  
  
  CONCLUSIONS
  With more intensive medical management in the community, a significant decrease in atherosclerotic risk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted.
authors.affiliation: From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada.
authors.forename: Chrysi
authors.initials: C
authors.lastname: Bogiatzi
authors.affiliation: From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.affiliation: From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada.
authors.forename: A Ian
authors.initials: AI
authors.lastname: McLeod
authors.affiliation: From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada. dspence@robarts.ca.
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: epidemiology; secondary prevention; stroke etiology; trends