Implications of changing trends in cerebrovascular and ischemic heart disease mortality

Status Report--Retracing the history of the early development of national chronic disease surveillance in Canada and the major role of the Laboratory Centre for Disease Control (LCDC) from 1972 to 2000

Health surveillance is the ongoing, systematic use of routinely collected health data to guide public health action in a timely fashion. This paper describes the creation and growth of national surveillance systems in Canada and their impact on chronic disease and injury prevention. In 2008, the authors started a review process to retrace the history of the early development of national chronic disease surveillance in Canada from 1960 to 2000. A 1967 publication describes the history of the development of the Laboratory of Hygiene from 1921 to 1967. This review is a sequel to that paper and describes the history of the development of national chronic disease surveillance in Canada before and after the formation of the Laboratory Centre for Disease Control (LCDC).

Epidemilogy of stroke in the Poznań district of Poland

The incidence of cerebrovascular disease was established in the Poznań district in Poland for 1985. Mortality from cerebrovascular disease during this year was compared with mortality during 1977. The autopsy material from the years 1925 to 1985 was analyzed to differentiate ischemic from hemorrhagic stroke. The incidence of stroke was 198.3 per 100,000 inhabitants greater than 20 years of age. Mortality from cerebrovascular disease decreased significantly in both males and females from 1977 to 1985. Analysis of the pattern of cerebrovascular disease in the autopsy material from 1925 to 1965 demonstrated an overwhelming percentage of hemorrhagic stroke. In the years that followed, an inversion was noticed in the ratio of ischemic to hemorrhagic stroke. It should be assumed that the growing efficacy of antihypertensive therapy largely explains the decreasing incidence of stroke-induced mortality.

Increasing incidence of stroke among Swedish women

The incidence of stroke and transient ischemic attack was studied prospectively in the municipality of Söderhamn, Sweden, during the periods 1975-1978 and 1983-1986. A total of 723 cases of stroke and 111 cases of transient ischemic attack were registered during the two periods. The number of first-ever strokes increased by 28% between the 1970s and the 1980s, while the annual incidence of first-ever stroke rose from 2.90 to 3.53/1,000 (p less than 0.02). Female incidence increased by 38%, from 2.62 to 3.62/1,000 (p less than 0.05) between the study periods. Male incidence, however, changed nonsignificantly from 3.19 in the first period to 3.43 in the second. In 1975-1978, male incidence was four times greater than that of females up to 65 years of age, but the distribution became balanced in 1983-1986, when the increment of female incidence was 47% in the group 25-44 years old and 232% (p less than 0.05) in the group 45-64 years old. The annual incidence of first-ever transient ischemic attack was 0.43/1,000 in men and 0.48/1,000 in women in 1975-1978. The corresponding rates for 1983-1986 were 0.56 and 0.45/1,000, respectively. These changes were not significant. The cause of the increase in the incidence of stroke among women has not been established.

Risk factors in asymptomatic patients with a carotid bruit

A consecutive series of 369 asymptomatic patients with a carotid bruit was prospectively followed with Ocular Pneumoplethysmography (OPG). The aim of the study was to identify those patients most prone to cerebrovascular ischemia and/or progression of obstructive carotid disease. During follow-up 13 patients developed a stroke of which six were fatal (two thrombo-embolic and four haemorrhagic strokes). TIA's occurred in 15 patients, including eight patients with amaurosis fugax. TIA's occurred more frequently on the side of a haemodynamically significant stenosis (9% = 9/95) than on the side of a normal, OPG (2% = 6/274). There was no difference in the strokelocated side. The occurrence of symptoms and/or signs of cerebrovascular disease was 4% at two years and 10% at five years. The left hemisphere was affected twice as often as the right. The development of a haemodynamically significant carotid stenosis, according to OPG, was equal for the right and the left carotid arteries, being 18% at two years and 56% after 5 years of follow-up. The major risk factors for progression of obstructive disease were systolic blood pressure above 160 mmHg independent of age, diabetes mellitus and the presence of ischaemic heart and peripheral arterial obstructive disease. This study supports the contention that in a group of patients with an asymptomatic carotid bruit, a group of patients at risk from cerebrovascular accidents can be filtered out by a simple non-invasive test in combination with a complete physical examination.

Trends in mortality from cerebrovascular disease in Taiwan

The rate of decline in the age-adjusted death rate from cerebrovascular disease (CVD) in Taiwan is not as rapid as in the United States and Japan, and the trends of CVD mortalities have not decreased steadily during the period 1972-1983. A low record of hypertension regulation (5.0%-12.7%), a high proportion (47.1%) of stroke due to cerebral hemorrhage (by clinical assessment), and a high fatality rate (40.1%) for cerebral hemorrhage may account partially for the slower declining rate. A geographic difference in the downward trend of CVD death rate was observed in this period. Districts remote from the major cities have had the lowest decline in CVD death rate.

Ejection fraction response of the left ventricle of the heart to acute cerebrovascular accident in patients with coronary artery disease

The ejection fraction (EF) of the left ventricle was measured by radionuclide ventriculography in 64 patients during an acute cerebrovascular accident. Sixteen patients (12 with coronary artery disease) died within two weeks of the onset of symptoms and had only one EF measurement. In the remaining 48 patients, the EF was also measured two weeks and three months after the acute event. The ejection fraction of the patient who died soon after the acute stroke (52 +/- 18) was significantly lower than that of the patients who survived (64 +/- 10) (p less than 0.01). Of the patients who survived, 28 without history of coronary disease had an EF of 67 +/- 10 during the acute event. It was significantly higher than that measured after two weeks (60 +/- 10) p less than 0.01). In 10 patients with history of chronic stable angina pectoris, the EF (59 +/- 10) was significantly lower in the first study compared to that measured in the second (69 +/- 10) (p less than 0.02). Ten patients with no evidence of ischemia but with a history of myocardial infarction had a higher EF (61 +/- 11) during the first study as compared to the second (51 +/- 11) (p less than 0.05). In all patients there was no significant difference in the EF measurements between the second and the third study. It is suggested that the EF response of the left ventricle of the heart to the acute cerebrovascular accident is similar to that observed in a stress test.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality from and incidence of stroke in Stockholm

To study trends in the incidence of and mortality from stroke in Stockholm during 1974-81 all cases (n = 56566) of stroke in patients aged over 40 were identified from the Swedish Cause of Death Register and the Inpatient Care Register. Information on the population at risk was obtained from the civil registration system. A multiplicative model was used to control for changes in the distribution of age during the study. Mortality from stroke decreased annually throughout the study by a mean of 2.3% for men and 3.5% for women. This favourable development was not accompanied by a similar decrease in the incidence of stroke. In men the total incidence (including recurrent strokes) and incidence of first stroke increased continuously. In women the total incidence showed virtually no change, whereas the incidence of first stroke decreased somewhat. These findings, in addition to an expected shift of age profile in the population towards more elderly people, should be considered in the planning of future health care resources.

Decline in mortality in Japan, USA, and the Federal Republic of Germany--the contribution of the specific causes of death

In Japan, total mortality of men and women in the age groups of 45-54, 55-64, and 65-74 years decreased, within the last three decades, by 50-60% to values which are now among the lowest in the world. During the same period, death rates of men decreased by approx. 20% in the USA and approx. 10% in the Federal Republic of Germany (FRG). As to women, decreases in both countries were over 30%. The decrease between 1968 and 1978 (period of validity of the 8th Revision of the ICD) in the three countries was mostly due to the diseases of the circulatory system: In Japan, mostly to cerebrovascular diseases, in the USA, to ischaemic heart diseases, and in the FRG, to other forms of heart diseases. Second to the diseases of the circulatory system, stomach cancer and infective and parasitic diseases contributed most to the total decrease in Japan, accidents and diseases of the respiratory system in the USA, and diseases of the respiratory and digestive systems in the FRG. The highest percentage increases of death rates for the specific causes were recorded for lung cancer in all three countries and for other forms of heart diseases in the USA.