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

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.

Keywords

Transient ischemic attack incidence stroke risk epidemiology methodology

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

Abstract

Objective

Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material