Stroke morbidity in Swedish- and Finnish-speaking populations of Turku, Finland.

OBJECTIVES: To examine differences in the morbidity and mortality of stroke between the Finnish- and Swedish-speaking populations in Turku, taking into account the socioeconomic differences between these groups. DESIGN: The population-based FINMONICA and FINSTROKE stroke registers recorded 5,135 stroke events among persons aged 25-99 years in Turku during 1988-1998. Events in persons aged > or =75 years were not registered in 1993-1995. Information on these persons' native language and socioeconomic status (SES) (measured by taxable income, profession and years of education) were obtained by record linkage with the files of Statistics Finland. RESULTS: Swedish-speaking men had a lower attack rate of ischaemic stroke than Finnish-speaking men (270, 95% Confidence Interval (CI) 214-326 versus 370, 95% CI 352-389, per 100,000 inhabitants per year) and the difference remained significant after adjustment for SES. Among women, the attack rates of ischaemic stroke were similar in both language groups. CONCLUSIONS: The attack rate of ischaemic stroke was lower among Swedish-speaking than among Finnish-speaking men. This difference was not totally explained by the higher SES of the Swedish-speaking population.

Impaired glucose tolerance as a risk factor for stroke in a cohort of non-institutionalised people aged 70 years.

OBJECTIVE: to determine whether impaired glucose tolerance (IGT) is associated with an increased likelihood for ischaemic stroke. DESIGN: prospective cohort study. PARTICIPANTS: a sample of 1,032 non-institutionalised people aged 70 years in the Turku Elderly Study, Turku, Finland. MEASUREMENTS: the association between IGT (defined as plasma glucose level between 7.80 and 11.09 mmol/l 2 h after administration of 75 g of an oral glucose load) and diabetes mellitus (DM) (defined as the current use of insulin or an oral hypoglycaemic medication, a fasting plasma glucose level of >/=7 mmol/l or a plasma glucose level of >/=11.1 mmol/l 2 h after administration of an oral glucose load) with 12-year follow-up for the development of ischaemic stroke. RESULTS: a total of 742 (71.9%) subjects had normal glucose tolerance, 127 (12.3%) subjects had IGT and 163 (15.8%) had DM. Patients were examined in the year 1990 and followed up for stroke occurrence until death or until the end of 2002. Mean follow-up time was 9.6 years (SD +/-3.3 years). In total, 119 patients (11.5%) suffered a stroke during the follow-up. In logistic regression model, previous stroke, previous TIA, DM and atrial fibrillation were risk factors for stroke occurrence. CONCLUSION: stroke tended to happen more often in the IGT group than in the normal group, but the difference was not statistically significant. Statistically significant risk factors for stroke in elderly people are previous TIA or stroke, DM and atrial fibrillation.

Diabetes worsens the outcome of acute ischemic stroke.

OBJECTIVE: To characterize acute stroke events in diabetic patients in a population-based stroke register and to determine the influence of diabetes on the outcome of acute stroke. METHODS: Four thousand three hundred and ninety patients were recorded in the FINMONICA and FINSTROKE registers after their first ischemic stroke from 1990 to 1998. We followed mortality and stroke outcome for up to 4 weeks after the onset of acute stroke. RESULTS: Of the 4390 patients who had had an ischemic stroke, 43.6% were male and 25.1% (1103) had diabetes. Their mean age was 72.4 (S.D. 12.0) years and this was similar in patients with and without diabetes (72.9 years versus 72.3 years, p=0.18). Subjects with diabetes were more likely to be hypertensive (55% versus 38%, p<0.001) and have a history of myocardial infarction (20% versus 16%, p<0.001) than the non-diabetic stroke patients. Mortality at 4 weeks from the onset was higher in diabetic than in non-diabetic patients (20.0% versus 16.9% p=0.020). At day 28 after the stroke attack, diabetic patients were more likely to be disabled when compared with non-diabetic subjects (43.3% versus 33.5%, p<0.001). Using logistic regression analysis, adjusted for age-group, sex, previous medical history (MI, AF or TIA), diabetes was found to be a significant predictor of disability after stroke (OR=1.51, 95% CI 1.27-1.81). CONCLUSIONS: Diabetes, which affected one-fourth of the ischemic stroke patients on our register, was associated with a higher risk of death and disability after the onset of stroke. Preventing diabetes in the elderly population improves the short-term prognosis of acute ischemic stroke.

Continuous 15-year decrease in incidence and mortality of stroke in Finland: the FINSTROKE study.

BACKGROUND AND PURPOSE: The purpose of this study was to analyze the incidence and mortality trends in stroke events among persons 25 to 74 years of age in Finland during 1983 to 1997. METHODS: The population-based FINSTROKE register recorded 5650 new strokes among persons 25 to 74 years of age in 2 geographical areas of Finland: 2770 in the Kuopio area (east central Finland) and 2880 in Turku (southwestern Finland). Of these, 3065 were men and 2585 were women. RESULTS: The rates of acute stroke events fell during the whole study period in both men and women. In both FINSTROKE areas combined, the average annual decline in the age-standardized incidence of first stroke events was 2.0% (95% confidence interval [CI], -2.8 to -1.2; P<0.001) among men and 1.7% (95% CI, -2.6 to -0.8; P<0.001) among women. The decline in the incidence of ischemic stroke was even steeper, 2.9%/y (95% CI, -4.9 to -1.1; P<0.001) among men and 3.1%/y (95% CI, -5.0 to -1.1; P<0.001) among women, whereas the incidence of intracerebral hemorrhage and subarachnoid hemorrhage did not change. Mortality from all stroke events declined in the FINSTROKE areas by 3.7%/y (95% CI, -5.3 to -2.0; P<0.001) among men and by 4.1%/y (95% CI, -5.9 to -2.4; P<0.001) among women. The 28-day case fatality of all stroke events also tended to decline, but the decline was of borderline statistical significance only (P=0.07 among men, P=0.05 among women). CONCLUSIONS: Incidence and mortality of stroke events declined significantly in these 2 register areas in Finland during the 15-year period of 1983 to 1997.

The risk of stroke following coronary revascularization -- a population-based long-term follow-up study.

OBJECTIVE: To study the incidence and risk factors of stroke after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). DESIGN: During 1983-1992, coronary revascularization procedures (n = 2160) were recorded in patients aged 35-64 years as part of the population-based FINMONICA Myocardial Infarction Register. The FINMONICA Stroke Register and National Hospital Discharge Register were used to ascertain subsequent stroke events in such patients. RESULTS: During the average follow-up of 5.83 years, 155 patients (7.2%) had a stroke. The cumulative incidence of stroke was 1.55% in the first year after revascularization and varied between 0.8 and 1.4% during subsequent years. In Cox proportional hazard models the relative risk of stroke was 3.01 (p = 0.0007) for a previous stroke, 2.61 (p = 0.0001) for diabetes mellitus, 2.15 (p = 0.007) for low income (compared with high income), 2.06 (p = 0.03) for male sex, and 1.43 (p = 0.02) for a 10-year increment in age. CONCLUSION: The incidence of stroke during the first year after revascularization was five times higher than among the age- and sex-matched general population. Patients with a previous stroke, diabetes mellitus, advanced age, male sex and low socioeconomic status need special attention because of increased risk of stroke after CABG or PTCA.