Transient ischemic attack: Incidence and early risk of stroke in northern Portugal from 1998–2000 to 2009–2011

Abstract

Objective A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal. Methods Data from two prospective community-based registers of first-ever TIA in 104,700 (1998–2000) and 118,232 (2009–2011) persons were collected using comprehensive case ascertainment methods. Incidence and stroke risk from TIA onset were compared using different inception cohorts. ABCD2 was used to stratified stroke risk. Results Overall, 141 patients were included in 1998–2000 and 174 in 2009–2011. Crude annual incidence rate increased from 67 to 74/100,000 (IRR=1.12; 95% CI, 0.90–1.40), particularly in men under 65 years (IRR=1.79; 95% CI, 1.06–3.04). Male/female IRR increased from 1.20 (0.86–1.68) in 1998–2000 to 1.77 (1.31–2.39) in 2009–2011, after adjustment for age. Better control of vascular risk factors (VRFs) accounted for lower ABCD2 scores in 2009–2011. The 30-day stroke risk was similar in study periods (18.4% vs. 16.7%, p > 0.7), decreasing from 16.1% to 8.2% ( p < 0.042) excluding patients reporting TIA after stroke occurrence and from 12.2% to 4.0% ( p < 0.011) further excluding patients who had stroke in ambulance/hospital. ABCD2 discriminated stroke risk only in 1998–2000; stroke severity decreased while posterior circulation stroke was more common in 2009–2011. Conclusion Despite a stable TIA incidence across periods, the risk increased in men compared to women. Better control of VRF accounted for lower ABCD2 scores and secondary prevention reduced stroke risk. Men under 65 years emerge as a preferential target for primary and secondary prevention.

Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

“…A total of 71 studies were included (A. Mowla, MD, unpublished data, 2020). 9 , 15 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ...…”

“…Patients were studied prospectively in 24 cohorts (23.8%). 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 By considering the health care setting for the index event, we recorded 101 distinct cohorts. Out of 101 cohorts, 16 (15.8%) included patients with TIA and mIS.…”

“… 15 , 33 , 34 , 35 , 36 , 37 , 40 , 61 , 67 , 68 , 81 , 85 , 87 , 93 The setting of care was not fully described or the study included the patients who received treatment in various care settings and multiple centers in 37 cohorts (87 303 patients; mean [SD] age, 70.8 [3.8] years, 43 495 of 87 303 [49.8%] men). 27 , 42 , 43 , 44 , 45 , 46 , 47 , 50 , 51 , 53 , 59 , 60 , 62 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 81 , 86 , 88 , 89 , 90 , 92 , 94 Eight studies 9 , 32 , 51 , 52 , 53 , 58 , 59 (and A. Mowla, MD, unpublished data, 2020) provided the outcome of the patients in both inpatient and TIA clinic cohorts. The risk of subsequent stroke was reported for 35 356 patients within 2 days, 36 134 patients within 7 days, 142 185 patients within 30 days, and 94 731 patients within 90 days.…”

“…As presented in the eTable 4 in the Supplement , the difference among estimated risk of subsequent stroke measured by seven estimators (DL, HE, HS, ML, REML, SJ, and EB) was negligible. The forest plots based on the REML estimator 43 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 96 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , …”

Review Cerebral Ischemic Tolerance and Preconditioning: Methods, Mechanisms, Clinical Applications, and Challenges

“…LIPreC, one of the earliest mechanical methods for mediating IPreC, can induce cerebral protective tolerance to the subsequent prolonged lethal I/R injury by short-term I/R of the brain tissue ( 92 ). Transient ischemic attacks (TIA) and clinical practice of surgical protection in organ transplantation provides convincing evidence for the effectiveness of LIPreC ( 92 – 95 ).…”