title: Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East.
abstract: Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.
authors.affiliation: 1 Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Saber
authors.affiliation: 2 Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
authors.affiliation: 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: 4 McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Shoamanesh
authors.affiliation: 5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amin
authors.initials: A
authors.lastname: Amiri
authors.affiliation: 5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohammad T
authors.initials: MT
authors.lastname: Farzadfard
authors.affiliation: 6 Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Réza
authors.initials: R
authors.lastname: Behrouz
authors.affiliation: 5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.|7 Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
authors.forename: Mahmoud Reza
authors.initials: MR
authors.lastname: Azarpazhooh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000145:classification / Q000453:epidemiology*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000453:epidemiology*
keywords: Stroke incidence; epidemiology; ischemic stroke; stroke survival