Changes in risk factors and preventive treatments by stroke subtypes over 20 years: A population-based study

In order to evaluate progress in preventive therapeutic strategies, and to identify potential targets for improvement, it is essential to assess changes in the risk factors and preventive treatment of stroke over time. All of the strokes occurring within the population of Dijon, France (150,000 inhabitants), were prospectively ascertained from 1985 to 2004. Changes in stroke risk factors and preventive medications were analyzed by stroke subtypes. We recorded 725 lacunar infarcts (LI), 497 cardioembolic (CE) strokes, 2054 ischemic stroke from atheroma of large arteries or from other and undetermined causes (OIS), and 341 primary cerebral haemorrhages (PCH). Over the 20 years, the prevalence of hypercholesterolemia increased whatever the stroke subtype (p < 0.01) whereas that of diabetes only rose in LI and OIS stroke. The proportion of stroke patients on antiplatelet agents increased overall (p < 0.01) and the proportion of patients on anticoagulants rose in CE stroke (p = 0.01) and PCH (p < 0.01). The proportion of patients on antihypertensive treatment only increased in CE stroke (p = 0.01).The risk factor profile and the preventive treatments in stroke patients showed divergent variations over the 20 years, according to the stroke subtype considered. These modifications certainly reflect changes in the therapeutic strategies for the preventive management of the population at risk.