Prevalence and incidence of transient ischaemic attack: a systematic review and meta-analysis

Transient ischaemic attack (TIA) is a strong predictor of stroke, has a high risk of recurrence, and may lead to a variety of sequelae. The purpose of this study was to understand the epidemiological characteristics and trends of TIA through a systematic review and meta-analysis, to identify high-risk populations, and to provide a basis for prevention and intervention measures.

Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched Chinese-language (CNKI, Wanfang, VIP, and CBM) and English-language databases (PubMed, Cochrane, Embase, and Web of Science) from inception to October 25, 2024. Cross-sectional or cohort studies reporting the prevalence or incidence of TIA were included. Quality assessment was performed using the AHRQ and NOS scales. Data synthesis was performed with Stata 17.0, employing a random-effects model for high heterogeneity (I² > 50%). Subgroup analyses were conducted on the basis of region, publication year, gender, age and diagnostic criteria.

From 20,114 screened records, 47 studies were included, contributing a total of 50 datasets for analysis (23 for prevalence and 27 for incidence). The global pooled prevalence of TIA was 1.95% (95% CI: 1.27-2.77%), and the prevalence was elevated in Asia (2.19%) and among older adults (> 65 years, 5.13%). The annual incidence was 54 per 100,000 person-years, with the highest incidence occurring in the Americas (81 per 100,000). No significant gender differences were found in terms of prevalence or incidence. The incidence decreased over time but increased with age. The use of imaging-based criteria is associated with a lower and likely more accurate estimation of TIA prevalence.

This study provides updated global estimates of TIA epidemiology, revealing significant variations influenced by diagnostic criteria, age, and region. The substantial heterogeneity and potential underreporting highlight the need for standardized, imaging-based diagnostic protocols in future research. The development of precise risk stratification tools and region-specific prevention strategies is imperative for mitigating the global burden of TIA.