October 8, 2010 (Las Vegas, Nevada) — A comparison of stroke patients presenting to emergency departments in the United States and Italy indicates that the average age at first stroke is decreasing in the former but is holding steady in the latter, according to a study presented here at the American College of Emergency Physicians 2010 Scientific Assembly.
The research follows a previous study from the same team of investigators showing decreasing age at first stroke among patients presenting to emergency departments during the past 14 years in the United States. Both studies support the theory that increasing risk factors in the United States may be behind the trend, according to lead study author Stephen Van Pelt, MD, a resident at Morristown Memorial Hospital in New Jersey.
"Our group conducted a recent study showing the average age of stroke was decreasing among our population over a 14-year period, despite better medications and primary care, and the authors at the time felt the decrease was probably due to obesity and other risk factors among our patient population," he said.
"We wanted to see if this was unique to our region or a more global effect, so we compared our rates to a hospital in Italy over a 6-year time period."
For the new study, the authors performed a retrospective review of 4,711,704 visits to emergency departments in New York and New Jersey and 433,043 visits in Italy between 2004 and 2009.
Cerebrovascular accident (CVA) patients were identified and represented 16,986 (0.36%) and 1369 (0.32%) visits at the US and Italian emergency departments, respectively.
Females represented 55% and 48% of CVA patients in the United States and Italy, respectively, and the average age of females in the United States decreased from 75.0 to 72.3 years during the 5 years of follow-up (difference, -2.7; 95% confidence interval [CI], -3.8 to -1.6; P < .0001), but it did not significantly change in Italy (76.8 to 78.2 years; difference, +1.5; 95% CI, -2.7 to 5.7; P = .48).
The average age of males in the United States decreased from 70.3 to 68.8 years (difference, -1.6; 95% CI, -0.4 to -2.7; P = .008), but did not significantly change in Italy (72.6 to 71.2 years; difference, -1.4; 95% CI, -4.4 to 1.6; P = .37).
"For women in Italy, there actually was a slight trend towards increasing age of stroke, but it was not statistically significant," Dr. Van Pelt said. "The Italian males meanwhile showed a trend towards decreasing age, but again, the figures were not significant."
A regression analyses yielded an R = .73 (P = .03) for females in the United States and R = .66 (P = .049) for US males for decreasing age at first stroke.
"The findings indicate that the age of stroke here in the US did significantly decrease among males and females between 2004 and 2009, and we speculate that the decrease may be due obesity and other risk factors for stroke that are more prominent in this country," Dr. Van Pelt concluded.
"Unfortunately, there's not much we can do in the emergency department other than try to help people get aggressive in controlling their risk factors and identifying stroke," he added. "So maybe counseling patients on managing their blood pressure, smoking, or improving their diabetes care might help out in the long run, but it's a widespread problem."
Obesity may indeed be a factor causing stroke rates to rise in the United States, but a more in-depth look at specific types of stroke may help shed more light on other factors, suggested Edward C. Jauch, MD, research director of the Division of Emergency Medicine and Department of Neurosciences at the Medical University of South Carolina in Charleston and moderator of the session.
"Recent research indicates that the overall incidence of stroke in the US is going down, but the exact cause is not clear. More and more young Americans are having strokes potentially due to increasing prevalence of diabetes, hypertension, and obesity, and we may also be seeing the benefit of improved prevention in our older patients by recognizing atrial fibrillation and providing appropriate anticoagulation, as well as overall improved prevention strategies," said Dr. Jauch.
"So we may be decreasing the risk of stroke in the elderly population but are challenged with our younger patient population with more stroke risk factors.
"It's hard to sort out all these potential factors into how the overall incidence of stroke is changing, but it might help to look at the stroke subtypes to see what's driving the change in age and work more aggressively in risk factor identification and management in our younger patients."
Dr. Van Pelt and Dr. Jauch have disclosed no relevant financial relationships.
American College of Emergency Physicians (ACEP) 2010 Scientific Assembly: Poster Abstract 239. Presented September 28, 2010.
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