Prevalence of stroke in Argentina: A door-to-door population-based study (EstEPA).

BACKGROUND: Stroke burden is highest and is still rising in low- and middle-income countries. Epidemiologic stroke data are lacking in many of these countries. Stroke prevalence in Argentina has been unexplored for almost three decades. AIM: This population-based study aims to determine prevalence of stroke in a representative sample of the Argentinean population. METHODS: We performed a door-to-door survey of randomly selected households in a city of 18,650 inhabitants. A structured questionnaire screening for potential stroke cases was used. All subjects screened positive were then evaluated by stroke neurologists for final adjudication. Data about stroke subtypes, neurological status, vascular risk factors, medications, and diagnostic tests were also collected. RESULTS: Among 2156 surveys, 294 were screened positive for a possible stroke. After neurological evaluation, there were 41 confirmed cases. The adjusted stroke prevalence was 1,974/100,000 inhabitants older than 40 years, and it was higher in men than in women (26.3‰ vs 13.2‰, p<0.01). Prevalence of ischemic stroke, intracranial hemorrhage, and transient ischemic attack were 15.8‰, 2.93‰, and 2.93‰, respectively. The most prevalent vascular risk factors in stroke survivors were hypertension, obstructive sleep apnea, and dyslipidemia. CONCLUSION: Approximately 2 in every 100 subjects older than 40 years in this population are stroke survivors. Stroke prevalence in Argentina has remained stable over the last 30 years; it is higher than in most Latin American countries and similar to western populations.

Fall in the Proportion of Atherothrombotic Strokes During the Last Decade.

OBJECTIVE: To determine the proportion of subtypes of ischemic strokes, vascular risk factors and treatment prior to stroke between 1997 and 2018 in a single institution in Argentina. METHODS: Demographics, risk factors, medications and TOAST subtypes were assessed and compared in ischemic stroke patients admitted during two periods of time, 1997-2007 (P1) and 2008-2018 (P2). RESULTS: There were 2747 patients (64% men, aged 67 ±15 years), 920 subjects in P1 and 1827 in P2. Age and gender distribution did not change over time. Proportion of large artery atherothrombotic strokes decreased from 29% in P1 to 14% in P2 (p <0.0001) and small vessel strokes from 15% to 11% (p <0.05). Cardioembolic and undetermined strokes increased from 17 to 25% (p <0.0001) and from 30% to 41% (p <0.0001), respectively. There were no changes in stroke of other etiologies (9% in both periods). Detection of atrial fibrillation increased from 14% to 19% (p<0.001). Use of medications prior to stroke increased for aspirin from 27% to 45% (p <0.0001), for antihypertensive drugs from 26% to 62% (p <0.0001), for statins from 14% to 42% (p<0.0001) and for anticoagulants from 4% to 9% (p<0.0001). CONCLUSIONS: The proportion of strokes associated to large and small vessel atherosclerosis is declining in our population with an increase in the proportion of cardioembolic and undetermined strokes. Better management of risk factors and higher prevalence and/or better screening for atrial fibrillation could explain, at least in part, these findings.