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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We examined the relation between the serum total cholesterol level and the risk of death from stroke during six years of follow-up in 350,977 men, 35 to 57 years of age, who had no history of heart attack and were not currently being treated for diabetes mellitus. The diagnosis of stroke and the type of stroke were obtained from death certificates. Using proportional-hazards regression to control for age, cigarette smoking, diastolic blood pressure, and race or ethnic group, we found that the six-year risk of death from intracranial hemorrhage (International Classification of Diseases, ninth edition [ICD-9], categories 431 and 432) was three times higher in men with serum cholesterol levels under 4.14 mmol per liter (160 mg per deciliter) than in those with higher cholesterol levels (P = 0.05 by omnibus test across five cholesterol levels). On the other hand, a positive association was observed between the serum cholesterol level and death from nonhemorrhagic stroke (P = 0.007). The inverse association of the serum cholesterol level with the risk of death from intracranial hemorrhage was confined to men with diastolic blood pressure greater than or equal to 90 mm Hg, in whom death from intracranial hemorrhage is relatively common. We conclude that there is an inverse relation between the serum cholesterol level and the risk of death from hemorrhagic stroke in middle-aged American men, but that its public health impact is overwhelmed by the positive association of higher serum cholesterol levels with death from nonhemorrhagic stroke and total cardiovascular disease (ICD-9 categories 390 through 459).
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PMID:Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. 279 8

In a population of slightly-more than one million persons, all cases of acute admission to hospital for cerebrovascular disease during 1984 were studied. Of the 2676 hospital admissions, 91% were of public-hospital patients. Of the 1908 patients who were aged more than 25 years and whose conditions were assigned the International classification of diseases' (ICD-9) codes (430-437) for cerebrovascular accidents, 1264 (1.8 patients per 1000 population of older than 25 years of age) cases were completed strokes, and 644 (1.0 patients per 1000 population of older than 25 years of age) cases were transient ischaemic attacks. There was no significant difference between the specific aetiological types of stroke that were diagnosed neuroradiologically and those that were diagnosed clinically. Among the cases of completed strokes, 54% of cases were thrombotic, 11% of cases were embolic, and 15% of cases were haemorrhagic, while nearly 20% of cases were unclassified. Twenty-one per cent of patients who were admitted to hospital with completed strokes died within two weeks of their admission, 28% of such patients were discharged home, 8% of such patients were transferred to full-maintenance care, and the remaining 43% of such patients were transferred for inpatient rehabilitation. The median length of stay for patients with completed strokes was 11.8 days compared with 6.2 days for patients with transient ischaemic attacks.
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PMID:Admissions, patterns of utilization and disposition of cases of acute stroke in Brisbane hospitals. 271 22

Over 8000 patients with cerebral thrombosis (ICD-8 number 433) hospitalised between 1970 and 1980 were surveyed retrospectively for outcome and additional diseases. The case-fatality rates and long-term prognosis of the patients were strongly affected by age, and the number of patients requiring permanent hospital care rose sharply with increasing age. The case-fatality rates in the different age groups were as follows: under 50 years 6%, 50-64 years 16%, 65-74 years 32%, 75-84 years 48% and over 85 years 66%. The cumulative survival rates at 1 and 5 years were as follows: under 50 years 54 and 46%, 50-64 years and 38%, 65-74 years 60 and 20% and over 75 years 45 and 10%. Clinical manifest coronary heart disease clearly affected the prognosis of patients under 75 years, but the impact diminished with rising age. Although hypertension led to an earlier onset of ischemic stroke, it did not significantly influence the survival prognosis. In patients over 75 years additional diseases, e.g. diabetes, had no significant effect on case-fatality or long-term prognosis underlining the malignant nature of cerebral thrombosis itself.
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PMID:Prognosis of elderly hospital patients with cerebral thrombosis. 314 11

Mortality rates for stroke in 1971, 1974, 1977, and 1980 were obtained for residents of Allegheny County in western Pennsylvania. Hospital case fatality ratios were also obtained in the same 4 years for those discharged with the diagnosis of stroke (ICD 430-438 of the Eighth and Ninth Revisions of the International Classification of Disease) in two large hospitals (greater than 400 beds). Age-adjusted mortality rates per 100,000 population have declined significantly in this period for the whole county as well as for the four sex-race groups. Case fatality ratio in the two hospitals of the study has decreased from 19.6 to 11%. A change in the severity of the disease manifested by a reduction in the number of comatose patients has occurred, and this reduction in comatose patients was responsible for greater than 80% of the decline in case fatality ratio. Coma appears to be the best predictor of mortality among hospitalized stroke cases (r = 0.6, p less than 0.00001). The recent introduction of computed tomography for the diagnosis of stroke in the late 1970s was accompanied by a twofold increase in the survivorship of stroke patients. However, this increase in survivorship may reflect selection bias and is based on ecological association. Further studies are needed to examine the role of computed tomography in improving survival.
Stroke 1988 Feb
PMID:Declining mortality from stroke in Allegheny County, Pennsylvania. Trends in case fatality and severity of disease, 1971-1980. 334 32

A total of 20,680 patients hospitalised in Helsinki during 1970-1980 due to cerebrovascular diseases were found when screening the Finnish National Hospital Discharge Register. The material was categorised according to three-digit ICD-8 diagnosis codes and age, and was analysed for case-fatality, length of stay and discharge status. By identifying all new cases an assessment of the incidence development during the study period was also possible. A fall in the overall age-standardised incidence of cerebrovascular disease was demonstrated, in accordance with disease register studies. The main reason was decline in incidence of haemorrhagic stoke (ICD-8 no. 431) and less well defined types of stroke (436-438). Ischaemic stroke (433), on the other hand, did not decrease in frequency. The diagnostic shift, occurring parallel with a growing mean age of patients, lead to decreasing acute mortality, increasing institutionalisation rates and longer stays in hospital, thus resulting in growing figures of hospital utilisation in spite of the declining incidence.
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PMID:Cerebrovascular disease: declining incidence but increasing hospital utilisation. 349 42

Over 21,000 hospital episodes due to cerebrovascular disease (CVD, ICD-8 nos. 430-438) were registered in the Helsinki hospitals in 1970-1980. Of those 17,629 were identified as new cases. The age-adjusted incidence of haemorrhagic and thrombotic stroke (430-433) declined during the period 1970-1975 from 221 to 139 cases/100,000 inhabitants, whereafter no further decrease was observed. The decline in incidence was significant in both sexes. Analysis by diagnosis group showed that the decrease was confined to the incidence of haemorrhagic stroke (430-432), whereas the incidence of thromboembolic stroke (433, 434) and transient ischaemic attacks (435) remained virtually unchanged. Survival was mainly determined by patient age and type of CVD. Intracerebral haemorrhage and occlusion of precerebral arteries exhibited the poorest short-term prognosis. About half of the patients hospitalised due to cerebral thrombosis and embolism survived over one year. Long-term prognosis of the major CVD groups was very poor with only 10% of the patients alive after eight years. Transient cerebral ischaemia and subarachnoid haemorrhage had a clearly better prognosis, the survival rates after eight years being 45 and 30%, respectively.
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PMID:The incidence and prognosis of cerebrovascular disease in hospital patients in Helsinki, Finland, in the decade 1970-1980. 359 65

The prevalence, reversibility, and mortality of secondary hypertension among 3783 patients with moderately severe nonmalignant hypertension attending the Glasgow (Scotland) Blood Pressure Clinic were assessed. Underlying causes of hypertension were found in 297 patients (7.9%). Eighty-seven patients (2.3%) were considered to have a potentially reversible cause for their hypertension, including the oral contraceptive pill (38 patients), renovascular disease (27 patients), and primary hyperaldosteronism (ten patients), but of these only 33 patients (0.9% of total clinic population) were cured by specific intervention. Two hundred ten patients (5.6%) had irreversible renal parenchymal disease and significantly higher mortality than men and women with other causes of hypertension. Excess deaths in the renal group were attributed to renal failure (International Classification of Diseases [ICD] 580 to 589) and vascular causes (ICD 390 to 458) but not to cancer (ICD 140 to 208; 235 to 239) or other nonvascular disease. These results suggest that investigation of hypertension for an underlying cause will reveal a small number of patients with treatable disorders, of whom only a few will be cured by specific intervention, and a moderate number with irreversible disease who are at high risk of myocardial infarction and stroke.
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PMID:Secondary hypertension in a blood pressure clinic. 360 86

Utah mortality rates for cerebrovascular disease (ICD numbers 430--438) are 13% below U.S. rates. About 70% of Utahns are members of the Church of Jesus Christ of Latter-day Saints, commonly called Mormons of LDS, which proscribes use of tobacco and alcohol. Other studies on this group have found significantly lower occurrence of many cancers and ischemic heart disease. We tested the hypothesis that Utah's lower cerebrovascular disease (CBVD) mortality was contributed by the LDS population. We classified by religion all CBVD deaths (2,521) (except subarachnoid hemorrhage and cerebral embolism) occurring in the state in 1968--1971. No significant difference was found between LDS and non-LDS, but both groups had mortality rates below U.S. expectation. Although recent studies have reported smoking to be a risk factor for CBVD, we found no consistent difference between the LDS and non-LDS, even in the younger age groups. The results do not support the hypothesis that tobacco is an important etiologic agent in CBVD mortality.
Stroke
PMID:Cerebrovascular disease in Utah, 1968--1971. 730 40

Cerebrovascular diseases (CVDs) constitute the most frequent cause of death in Spain. In order to identify the geographical pattern of CVD mortality, age- and sex-specific as well as age-adjusted mortality rates (ICD-8,9 rubrics 430-438) were calculated for the period 1975-1986 for each province in the country. Maps were constructed after categorization of mortality rates by quintile levels. In general, the geographical pattern was similar for the different age and sex strata. While most provinces in the northern half presented low or medium mortality, geographical areas located in the south, displayed rates in the uppermost quintiles. These results suggest that the spatial distribution of CVD mortality in Spain is not random and that the potential determinants underlying this geographical distribution, such as type of stroke, incidence, fatality, diagnostic or certification practices and competing causes of death, have an impact that is independent of age and sex and strongly associated with spatial location. Furthermore, these results can help in identifying high-risk populations.
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PMID:Spatial distribution of stroke mortality in Spain, 1975-1986. 764 50

Thirty-four patients underwent implantation of a third generation ICD, the 4210 ATP, for sudden cardiac death or ventricular tachycardia. This device incorporates significant telemetry logs as well as a detailed analysis of each arrhythmia episode detected. During the period of clinical follow-up, a mean of 12.2 months, a total of 26,569 VT or VF detections were made. The vast majority of these were either due to atrial fibrillation, nonsustained VT, or "noise" detection, and only 6% led to device therapy. ATP was successful in 86.3% of episodes, with 3.5% accelerations and 2.4% failure of ATP trains. The majority of inappropriate therapy episodes were clustered in seven patients, and all were easily diagnosed with the aid of the extensive telemetry logs and sense histories. Of five late deaths, three were from congestive heart failure, one from cerebrovascular accident, and one unknown. These data reveal that this "tiered" therapy noncommitted ICD performs to expectations; the stored data is of significant value in diagnosing the cause of ICD therapy. In addition, ATP is an effective modality for termination of VT.
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PMID:Changing trends in therapy delivery with a third generation noncommitted implantable defibrillator: results of a large single center clinical trial. 768 64


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