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. 2011 Jan 1;1(2):e000269.
doi: 10.1136/bmjopen-2011-000269.

UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database

Sally Lee  1 , Anna C E Shafe, Martin R Cowie
Affiliations

UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database

Sally Lee et al. BMJ Open. .

Abstract

Objectives: Stroke is a major cause of morbidity and mortality. This study aimed to investigate secular trends in stroke across the UK.

Design: This study aimed to investigate recent trends in the epidemiology of stroke in the UK. The study was a time-trend analysis from 1999 to 2008 within the UK General Practice Research Database. Outcome measures were incidence and prevalence of stroke, stroke mortality, rate of secondary cardiovascular events, and prescribing of pharmacological therapy for primary and secondary prevention of cardiovascular disease.

Results: The study cohort included 32,151 patients with a first stroke. Stroke incidence fell by 30%, from 1.48/1000 person-years in 1999 to 1.04/1000 person-years in 2008 (p<0.001). Stroke prevalence increased by 12.5%, from 6.40/1000 in 1999 to 7.20/1000 in 2008 (p<0.001). 56-day mortality after first stroke reduced from 21% in 1999 to 12% in 2008 (p<0.0001). Prescribing of drugs to control cardiovascular risk factors increased consistently over the study period, particularly for lipid lowering agents and antihypertensive agents. In patients with atrial fibrillation, use of anticoagulants prior to first stroke did not increase with increasing stroke risk.

Conclusion: Stroke incidence in the UK has decreased and survival after stroke has improved in the past 10 years. Improved drug treatment in primary care is likely to be a major contributor to this, with better control of risk factors both before and after incident stroke. There is, however, scope for further improvement in risk factor reduction in high-risk patients with atrial fibrillation.

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Conflict of interest statement

Competing interests: MRC provides consultancy advice to a number of pharmaceutical companies that might have an interest in the submitted work in the previous 3 years, including a consultancy contract to advise the Boehringer Ingelheim epidemiology team on CV analyses. SL and AS are employees of Boehringer Ingelheim Ltd, who market a number of cardiovascular therapies and might have an interest in the submitted work in the previous 3 years; SL and AS received no support from any other organisation for the submitted work.

Figures

Figure 1
Figure 1
Incidence (A) and prevalence (B) of stroke in the UK adult population by age group.
Figure 2
Figure 2
Stroke mortality within 56 days of first stroke by age group.
Figure 3
Figure 3
Pharmaceutical therapies prior to first stroke (A) and in the year following first stroke (B).
Figure 4
Figure 4
Percentage of GP-coded AF patients treated with anticoagulant and antiplatelet therapy prior to stroke by CHADS2 score. AF, atrial fibrillation; GP, general practitioner.
See this image and copyright information in PMC

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