Association between albuminuria, glomerular filtration rate and mortality or recurrence in stroke patients.

BACKGROUND/AIMS: In an attempt to find new predictors of stroke prognosis, we evaluated the association of albuminuria (AUr) and the estimated glomerular filtration rate (eGFR) with the recurrence of stroke and mortality. METHODS: We evaluated and followed for at least 7 months patients with first-ever stroke or transient ischemic attack admitted to a prospective cohort from March 2005 to December 2007. We analyzed traditional CV risk factors, albumin-to-creatinine ratio and eGFR (ml/min/1.73 m(2)) as predictors of mortality or recurrence. RESULTS: From a total of 185 patients included [57% (104/185) men, 64 ± 13 years], 38 patients suffered from a recurrent stroke or died, with a mean follow-up of 25.1 ± 8.7 months. AUr (≥30 mg/g) was found in 50.2% (93/185), and 38.9% (72/185) presented an eGFR <60. In univariate analysis, age >65 years, eGFR ≤50, atrial fibrillation (AF), no alcohol intake and AUr >17 mg/g were associated with the composite endpoint. In a multivariate analysis, AF and AUr >17 mg/g were independent predictors of the composite endpoints, but eGFR ≤50 was not. CONCLUSION: The presence of AUr >17 mg/g is independently associated with death or recurrence after stroke. Further studies should consider the AUr as a predictor for a worse prognosis in these patients.

Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study.

BACKGROUND: There have been few population based studies on stroke risk factors and prognosis conducted in Brazil. The objective of this study was to evaluate, over a 2 year period, the incidence of the subtypes of first ever stroke, the prevalence of cardiovascular risk factors and functional prognosis in a city located in the south of Brazil. METHODS: The period from January 2005 to December 2006 was evaluated prospectively by compiling data on first ever stroke cases, medications used prior to the morbidity and the incidence of traditional risk factors. The annual incidence was adjusted for age using the direct method. Patients were monitored for at least 6 months following the event. RESULTS: Of 1323 stroke cases, 759 were first ever stroke cases. Of these, 610 were classified as infarctions, 94 as intracerebral haemorrhage and 55 as subarachnoid haemorrhage. The crude incidence rate per 100 000 inhabitants was 61.8 for infarction (95% CI 57.0 to 66.9), 9.5 for intracerebral haemorrhage (95% CI 7.7 to 11.6) and 5.6 for subarachnoid haemorrhage (95% CI 4.2 to 7.3). The 30 day case fatality was 19.1%. The most prevalent cardiovascular risk factor was arterial hypertension. By post-stroke month 6, 25% had died (95% CI 21.4 to 29.1) whereas 61.5% had regained their independence (95% CI 56.2 to 68.3). CONCLUSIONS: Case fatality rate, prognosis and incidence adjusted for stroke subtypes were similar to those found in other population based studies. The prevalence rates of ischaemic heart disease, dyslipidaemia, arterial hypertension and diabetes suggest that Joinville presents a mixed pattern of cardiovascular risk, a pattern seen in developed and developing countries alike.

Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995-2006.

BACKGROUND: Studying stroke rates in a whole community is a rational way to assess the quality of patient care and primary prevention. However, there are few studies of trends in stroke rates worldwide and none in Brazil. OBJECTIVE: Established study methods were used to define the rates for first ever stroke in a defined population in Brazil compared with similar data obtained and published in 1995. METHODS: All stroke cases occurring in the city of Joinville during 2005-2006 were prospectively ascertained. Crude incidence and mortality rates were determined, and age adjusted rates and 30 day case fatality were calculated and compared with the 1995 data. RESULTS: Of the 1323 stroke cases registered, 759 were first ever strokes. The incidence rate per 100 000 was 105.4 (95% CI 98.0 to 113.2), mortality rate was 23.9 (95% CI 20.4 to 27.8) and the 30 day case fatality was 19.1%. Compared with the 1995 data, we found that the incidence had decreased by 27%, mortality decreased by 37% and the 30 day case fatality decreased by 28%. CONCLUSIONS: Using defined criteria we showed that in an industrial southern Brazilian city, stroke rates are similar to those from developed countries. A significant decrease in stroke rates over the past decade was also found, suggesting an improvement in primary prevention and inpatient care of stroke patients in Joinville.