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Secular trends in stroke in the Framingham Study

P A Wolf¹, R B D'Agostino

¹Department of Neurology, Boston University School of Medicine, MA.

Annals of Epidemiology

|September 1, 1993

Summary

Stroke incidence remained stable, but stroke severity significantly decreased over three decades. Declines in stroke severity were observed, but not consistently across all stroke types or for all individuals.

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Area of Science:

Neurology
Epidemiology
Public Health

Background:

Understanding long-term trends in stroke is crucial for public health initiatives.
The Framingham Heart Study provides a unique, long-term dataset for examining cardiovascular disease trends.

Purpose of the Study:

To analyze trends in stroke incidence, prevalence, fatality, and severity over three decades.
To investigate changes in stroke characteristics among individuals aged 55-64 in the Framingham Study.

Main Methods:

Longitudinal cohort study analyzing stroke events in Framingham Study participants.
Data collected across three successive decades: 1953-1963, 1963-1973, and 1973-1983.
Focus on stroke incidence, prevalence, case-fatality rates, and stroke severity metrics.

Main Results:

No significant decline in overall stroke or transient ischemic attack (TIA) incidence or prevalence.
Significant decrease in stroke severity, with less frequent severe neurologic deficit and unconsciousness on hospital admission.
Incidence of completed ischemic stroke declined significantly in women but not in men; hemorrhage trends did not explain severity decline.

Conclusions:

While overall stroke incidence remained stable, stroke severity significantly improved over the study period.
The increase in isolated TIAs contributed to an apparent decline in case-fatality rates, particularly in men.
Secular trends in stroke incidence and fatality did not follow a simple pattern, highlighting complex etiological factors.

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