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Tackling the global burden of stroke: the need for large-scale international studies

Published on Apr 1, 2009in Lancet Neurology28.75
· DOI :10.1016/S1474-4422(09)70024-9
Martin O'Donnell6
Estimated H-index: 6
(Population Health Research Institute),
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute)
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Abstract
To be eff ective, global and regional strategies to reduce the incidence and prevalence of stroke require an understanding of the frequency and determinants of stroke in diverse geographical locations and diff erent ethnic groups. In this issue of The Lancet Neurology, Feigin and co-workers and Johnston and co-workers present important and related epidemiological observations on global stroke incidence. Feigin and co-workers report on the divergence in stroke incidence between low to middle income countries (100% increase) and highincome countries (42% reduction) over the past four decades, whereas Johnston and co-workers show that current approaches used to measure and monitor global determinants of stroke do not provide convincing explanations for these regional diff erences. Given the available information, both articles are exhaustive and complete. However, the data are limited, and were obtained in diff erent ways, and during diff erent periods. Therefore, our ability to compare and integrate information across these studies is restricted. These studies highlight the current defi cits in the study of the determinants of global stroke incidence, particularly in low-income and middle-income countries, in which most strokes occur. Three types of clinical or epidemiological study are needed: large international standardised registries that document the characteristics, presentation, management, and outcomes after stroke, to understand the variations in practice patterns and outcomes in diff erent countries; large standardised case–control studies to clarify whether risk factors for stroke (and its subtypes) vary among regions, ethnic groups, or socioeconomic categories; and large surveillance programmes at sentinel sites in diff erent regions worldwide, to track secular changes in risk factors, key treatments, and stroke rates (eg, SinoMONICA). Despite the importance of stroke as a major publichealth problem, our understanding of the global epidemiology of stroke is incomplete and lags behind our knowledge of conditions such as coronary heart disease. Throughout the past decade, large international studies have advanced our understanding of regional variations in the incidence and risk factors for acute coronary syndromes (eg, INTERHEART) and their management and outcomes (eg, the GRACE and CREATE registries). Such studies have enabled us to tailor populationbased prevention and treatment strategies to such regional variation. Similar studies are now needed in best designs for clinical trials. Additionally, as Collinge and co-workers also note, earlier and improved diagnosis is a crucial advance that will add more power to future trials.
  • References (9)
  • Citations (23)
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References9
Newest
Published on Apr 1, 2009in Lancet Neurology28.75
Valery L. Feigin70
Estimated H-index: 70
(AUT: Auckland University of Technology),
Carlene M. M. Lawes37
Estimated H-index: 37
(University of Auckland)
+ 2 AuthorsVarsha Parag31
Estimated H-index: 31
(University of Auckland)
Summary This systematic review of population-based studies of the incidence and early (21 days to 1 month) case fatality of stroke is based on studies published from 1970 to 2008. Stroke incidence (incident strokes only) and case fatality from 21 days to 1 month post-stroke were analysed by four decades of study, two country income groups (high-income countries and low to middle income countries, in accordance with the World Bank's country classification) and, when possible, by stroke pathologic...
Published on Apr 1, 2009in Lancet Neurology28.75
S. Claiborne Johnston80
Estimated H-index: 80
(UCSF: University of California, San Francisco),
Shanthi Mendis36
Estimated H-index: 36
(WHO: World Health Organization),
Colin Mathers80
Estimated H-index: 80
(WHO: World Health Organization)
Summary Background Recent improvements in the monitoring and modelling of stroke have led to more reliable estimates of stroke mortality and burden worldwide. However, little is known about the global distribution of stroke and its relations to the prevalence of cardiovascular disease risk factors and sociodemographic and economic characteristics. Methods National estimates of stroke mortality and burden (measured in disability-adjusted life years [DALYs]) were calculated from monitoring vital s...
Published on Jun 1, 2008in Stroke6.05
Dong Zhao30
Estimated H-index: 30
(Capital Medical University),
Jen-pei Liu33
Estimated H-index: 33
(Capital Medical University)
+ 5 AuthorsZhaosu Wu10
Estimated H-index: 10
(Capital Medical University)
Background and Purpose— Epidemiological patterns of stroke may change with economic development. It is important to understand these changes for making timely strategies for stroke prevention. The aim of this study was to examine the changes in trends of stroke epidemiology during a period of fast economic development in China, based on data of the Sino-MONICA-Beijing project. Methods— Acute stroke events were registered in a large defined population aged 25 through 74 years from 1984 to 2004. T...
Published on Apr 1, 2008in The Lancet59.10
Denis Xavier47
Estimated H-index: 47
(St. John's Medical College),
Prem Pais42
Estimated H-index: 42
(St. John's Medical College)
+ 12 AuthorsS Thanikachalam1
Estimated H-index: 1
(SRU: Sri Ramachandra University)
Summary Background India has the highest burden of acute coronary syndromes in the world, yet little is known about the treatments and outcomes of these diseases. We aimed to document the characteristics, treatments, and outcomes of patients with acute coronary syndromes who were admitted to hospitals in India. Methods We did a prospective registry study in 89 centres from 10 regions and 50 cities in India. Eligible patients had suspected acute myocardial infarction with definite electrocardiogr...
Published on Aug 2, 2007in The New England Journal of Medicine70.67
Jonathan R. Carapetis58
Estimated H-index: 58
Rheumatic fever has receded as an important health problem in wealthy countries. Dr. Jonathan Carapetis writes that for everyone else, rheumatic fever and rheumatic heart disease are bigger problems than ever and warrant urgent attention.
Published on Feb 1, 2007in Lancet Neurology28.75
Thomas Truelsen46
Estimated H-index: 46
(Copenhagen University Hospital),
Peter U. Heuschmann42
Estimated H-index: 42
(WWU: University of Münster)
+ 9 AuthorsK Radhakrishnan1
Estimated H-index: 1
Summary Background Stroke is a leading global cause of death, with an estimated 5·8 million fatal events in 2005, two-thirds of which happened in low-income and middle-income countries. In these regions, epidemiological methods to establish hospital-based stroke registers for clinical audit or studies to estimate incidence are scarce. Our aim was to ascertain whether stroke registers could be set up in geographically diverse populations in low-income and middle-income countries, using standardis...
Published on Sep 1, 2004in The Lancet59.10
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(Population Health Research Institute),
Steven Hawken4
Estimated H-index: 4
(Population Health Research Institute)
+ 8 AuthorsJohn Varigos3
Estimated H-index: 3
(Population Health Research Institute)
Summary Background Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown. Methods We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15 152 cases a...
Published on Aug 1, 2002in European Heart Journal23.24
Keith A.A. Fox16
Estimated H-index: 16
,
Shaun G. Goodman74
Estimated H-index: 74
+ 4 AuthorsAlvaro Avezum70
Estimated H-index: 70
Aims Despite advances in the treatment of acute coronary syndromes based on randomized trial data and published guidelines, the extent to which such treatments are applied in practice remains uncertain. Data from clinical trials derive from selected geographical areas and in highly selected populations of patients, and hence may not reflect the overall population. The aim of the study was to investigate variations in hospital management and outcome using unselected data collected in the prospect...
Published on Jul 22, 2000in BMJ27.60
Suzanne J. Maynard6
Estimated H-index: 6
,
G O Scott1
Estimated H-index: 1
+ 1 AuthorsA A J Adgey1
Estimated H-index: 1
The acute coronary syndromes consist of two groups: unstable angina and non-Q wave myocardial infarction, and ST segment elevation myocardial infarction. This article reviews the management only of patients with unstable angina and non-Q wave myocardial infarction. Unstable angina can be defined as ischaemic-type chest pain that is more frequent, severe, or prolonged than the patient's usual angina symptoms, occurs at rest or minimal exertion, or is difficult to control with drugs.1 Angina of re...
Cited By23
Newest
Published on Jul 15, 2019in Inflammopharmacology3.84
Cijo George Vazhappilly (American University of Ras Al Khaimah), Shabbir A. Ansari2
Estimated H-index: 2
(University of Texas Health Science Center at Tyler)
+ 8 AuthorsRachel Matar1
Estimated H-index: 1
(American University of Ras Al Khaimah)
The failure of mechanisms of natural anti-coagulation either due to genetic impairment or due to severe external injuries may result in a condition called thrombosis. This is believed to be the primary cause for a variety of life-threatening conditions such as: heart attack, stroke, pulmonary embolism, thrombophlebitis, and deep venous thrombosis (DVT). The growing number of these incidents requires an alternative anti-coagulant or anti-thrombotic agent that has minimal side effects and improved...
Published on Mar 1, 2019in Neuroscience Letters2.17
Efthimios Dardiotis20
Estimated H-index: 20
(UTH: University of Thessaly),
Vasileios Siokas6
Estimated H-index: 6
(UTH: University of Thessaly)
+ 10 AuthorsEftychia Z. Kapsalaki24
Estimated H-index: 24
(UTH: University of Thessaly)
Abstract Backround A relatively small number of genetic variants are implicated to pathophysiology of intracerebral hemorrhage (ICH). Aquaporin-4 (AQP4) has been reported to be implicated in the pathophysiological processes of ICH development. Objective To examine the role of AQP4 gene region polymorphisms on the ICH risk. Methods A total of 250 Greek and 193 Polish patients with primary ICH and 250 and 322 respective controls were enrolled, forming two independent cohorts in order to validate a...
Published on Dec 1, 2018in Scientific Reports4.01
Tingwang Guo3
Estimated H-index: 3
(Chongqing University),
Peng Ren2
Estimated H-index: 2
(Chongqing University)
+ 4 AuthorsBochu Wang29
Estimated H-index: 29
(Chongqing University)
Mass effect induced by growing hematoma is one of the mechanisms by which intracerebral hemorrhage (ICH) may result in brain injuries. Our goal was to investigate the damage mechanism of hydrostatic pressure associated with mass effect and the cooperative effect of hydrostatic pressure plus hemoglobin on neural injuries. Loading hydrostatic pressure on neurons and injecting agarose gel in the right striatum of rats was performed to establish the in vitro and vivo ICH models, respectively. The el...
Published on Jun 1, 2018in World Neurosurgery1.72
Umit Eroglu2
Estimated H-index: 2
(Ankara University),
Gokmen Kahilogullari11
Estimated H-index: 11
(Ankara University)
+ 5 AuthorsHasan Caglar Ugur17
Estimated H-index: 17
(Ankara University)
Objective Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment. Methods We compared intracerebral hematoma drainage in 2 grou...
Published on Jun 1, 2018in Translational Stroke Research
Naveed Akhtar18
Estimated H-index: 18
(Hamad Medical Corporation),
Abdul Salam11
Estimated H-index: 11
(Hamad Medical Corporation)
+ 11 AuthorsZain A. Bhutta3
Estimated H-index: 3
(Hamad Medical Corporation)
Asymptomatic small vessel disease (SVD), including white matter hyperintensities (WMHIs), periventricular hyperintensities (PVHIs), silent stroke (SS), and cerebral microbleeds (CMBs), increases the risk of stroke. There are limited studies of SVD in subjects from the Middle East and Southeast Asia (SA). All patients admitted to stroke service between 2014 and 2015 were reviewed for presence of “pre-existing” SVD. Stroke mimics with no previous history of stroke were used as controls. There were...
Published on Sep 1, 2016
Naveed Akhtar18
Estimated H-index: 18
(Hamad Medical Corporation),
Abdul Salam11
Estimated H-index: 11
(Hamad Medical Corporation)
+ 8 AuthorsRayaz A. Malik51
Estimated H-index: 51
(Cornell University)
ObjectiveWe analysed the Qatar stroke registry for ethnic variations in patients admitted with cerebrovascular disease at Hamad General Hospital, Qatar.MethodsPatients admitted with acute stroke from January 2014 to December 2015, enrolled in the registry were included in the study. We evaluated the clinical presentation, risk factors, and outcome at discharge and 90 days post-discharge in relation to the patient’s ethnic background.ResultsA total of 1727 patients were enrolled in the Hamad Gene...
Published on Aug 1, 2016in The Lancet59.10
Martin O'Donnell50
Estimated H-index: 50
(National University of Ireland, Galway),
Siu Lim Chin3
Estimated H-index: 3
(Population Health Research Institute)
+ 43 AuthorsSteven Agapay1
Estimated H-index: 1
(Population Health Research Institute)
Summary Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute firs...
Published on Jun 15, 2016in Acta Medica Medianae
Biljana Živadinović1
Estimated H-index: 1
,
Dragan Stojanov9
Estimated H-index: 9
+ 1 AuthorsJelena Stamenović
Carotid artery stenosis is a widespread disease and it is one of the most significant risk factors for the development of ischemic stroke. The risk of ischemic stroke increases with the increase in the degree of carotid artery stenosis. Although the relation between carotid artery stenosis and other risk factors (arterial hypertension, hyperlipidemia, diabetes, etc.) has not been precisely determined in relation to the development, course and outcome of the ischemic stroke, the degree of this as...
Published on Dec 7, 2015in PLOS ONE2.78
Zhiming Zhou1
Estimated H-index: 1
(Wannan Medical College),
Xianhui Ding1
Estimated H-index: 1
(Wannan Medical College)
+ 5 AuthorsTaofeng Zhou1
Estimated H-index: 1
(Wannan Medical College)
Background Polymorphisms of the brain-derived neurotrophic factor (BDNF) have been investigated as candidate genes for post-stroke depression (PSD), and its receptor, neurotrophic tyrosine kinase receptor B (TrkB), has been associated with depression. However, no further data have yet reported the association between PSD and polymorphisms in TrkB. This study aims to investigate whether a relationship exists between TrkB polymorphisms and PSD.
Published on Aug 6, 2015in Global Journal of Health Science
Tatan Saefudin1
Estimated H-index: 1
,
Nursama Heru Apriantoro4
Estimated H-index: 4
+ 1 AuthorsSchandra Purnamawati1
Estimated H-index: 1
Haemorrhagic Stroke is a common disease in Indonesia. The best imaging modality for this disease is Multi Slice Computed Tomography Scanning (MSCT), as it may help strengthening the diagnosis as well as determining the brain bleeding volume. This study aimed to show correlation between bleeding volume of the brain and patient’s age using cross-sectional approach. The 68 samples in this study were taken from secondary data from Head CT Scan of Haemorrhagic Stroke cases. Brain bleeding volume is t...
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