Ischemic stroke in a general population: Time trends in incidence, case fatality and the impact of risk factors.

• Main Author: Vangen-Lønne, Anne Merete
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: UiT The Arctic University of Norway 2017
• Subjects: VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803; VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803; The Tromsø Study; Tromsøundersøkelsen; Carlsson; Norway; Tromsø
• Online Access: https://hdl.handle.net/10037/11665

The papers of this thesis are not available in Munin. Paper I: Vangen-Lønne, A. M., Wilsgaard, T., Johnsen, S. H., Carlsson, M., Mathiesen, E. B.: “Time trends in incidence and case fatality of ischemic stroke: The Tromsø study 1977–2010”. Available in Stroke 2015, 46: 1173–1179. Paper II: Vangen-Lønne, A. M., Wilsgaard, T., Johnsen, S. H., Løchen, M. L., Njølstad, I., Mathiesen, E. B.: “Declining incidence of ischemic stroke: What is the impact of changing risk factors? The Tromsø study 1995–2010”. Available in Stroke. 2017;48: 544–550. Paper III: Vangen-Lønne, A. M., Ueda, P., Gulayin, P., Wilsgaard, T., Mathiesen, E. B., Danaei, G.: «Hypothetical interventions to prevent stroke: An application of the parametric g-formula to a healthy middle-aged population”. (Manuscript). About 80-85% of all strokes are due to reduced blood flow to the brain (ischemic strokes). Lack of knowledge regarding time trends in incidence and case fatality of ischemic stroke in Norway represented a main motivation for this study. Data from the Tromsø Study, following >40,000 attendees from six surveys through 2012, provided an excellent opportunity to reveal time trends of ischemic stroke and assess the potential mechanisms behind these trends in a general population. We found that the overall age- and sex adjusted incidence of ischemic stroke declined with 27% from 1995–2012 in persons aged ≥30 years. The time trends differed by age, with increasing incidence in women aged 30-49 years, a non-significant rising trend among men 30–49 years, and declining incidence in women aged 50–74 and men aged 65–74 years. In men 50–64 and among those ≥75 years, the ischemic stroke incidence in 2012 did not differ from the incidence two decades earlier. The age-adjusted 30-days case fatality decreased in men aged 30-84 years but not in women or in attendees ≥85 years. Overall, the combined changes in seven cardiovascular risk factors (systolic blood pressure, total cholesterol, HDL, daily smoking, physical activity, diabetes and body mass ...