Based on the AHA Heart Disease and Stroke Statistics–2007 Update
Facts about acute ischemic stroke
In 2007, the American Heart Association Statistics Subcommittee and Stroke Statistics Subcommittee published "Heart Disease and Stroke Statistics—2007 Update" (Circulation. 2007;115:e69-e171.)
Incidence
- Annually, about 700,000 people have a new or recurrent stroke
- Approximately 500,000 of these strokes are first attacks and about 200,000 are recurrent attacks
- On average, in the United States, every 45 seconds someone has a stroke
- Each year, about 46,000 more women than men have a stroke
- Men have a higher incidence of stroke at younger ages but not at older ages. The male/female incidence is 1.25 in people 55 to 64 years of age; 1.50 in those 65 to 74 years of age; 1.07 in those 75 to 84 years of age; and 0.76 in people age 85 years and older
- 87% of all strokes are ischemic. The remainder are intracerebral and subarachnoid hemorrhage strokes
Mortality
- In 2004, stroke caused approximately 1 out of every 16 deaths in the United States
- Stroke is the third leading cause of death in the United States, ranking behind only heart disease and cancer
- On average, every 3 to 4 minutes, someone dies of a stroke
- The 2004 overall death rate for stroke was 50.0. Death rates were 48.1 for white males, 73.9 for black males, 47.4 for white females, and 64.9 for black females
- Because women live longer than men, more women than men die of stroke each year. In 2004, 61% of US stroke deaths were among women
- About 50% of stroke deaths in 2003 occurred outside the hospital setting
- Death certificate data from 2002 showed that the mean age at stroke death was 79.6 years. However, males had a younger mean age at stroke death than females
Risk Factors
- In adults over 55 years of age, the lifetime risk for stroke is greater than 1 in 6. Women have a higher risk of stroke than men, which may be owing to women's survival advantage
- Blood pressure is a powerful risk factor for stroke. Those with blood pressure less than 120/80 mm Hg have about half the lifetime risk of stroke as those with hypertension
- The relative risk of stroke in heavy smokers (those smoking more than 40 cigarettes a day) is twice that of light smokers (those smoking less than 10 cigarettes a day). Stroke risk decreases significantly 2 years after cessation of cigarette smoking and is reduced to the level of nonsmokers by 5 years of abstinence
- Data from the Women's Health Study, which examined stroke risk factors in more than 37,000 women aged 45 or older, suggests that a healthy lifestyle consisting of moderate alcohol consumption, regular exercise, a healthy diet, low body mass index, and abstinence from smoking were associated with a significantly reduced risk of total and ischemic stroke, but not of hemorrhagic stroke
- The risk of ischemic stroke or intracerebral hemorrhage during pregnancy and the first 6 weeks postpartum was 2.4 times greater than for nonpregnant women of similar age and race, according to the Baltimore-Washington Cooperative Young Stroke Study
- Stroke is a major health issue for postmenopausal women in particular, which raises the question: is increased incidence of stroke in this population due to aging or to hormone status?
- Administration of estrogen plus progestin increased ischemic stroke risk by 44% among 16,608 postmenopausal women who were generally healthy, according to the Women's Health Initiative primary prevention clinical trial. However, estrogen plus progestin had no effect on the risk of hemorrhagic stroke
- Physical activity reduces stroke risk. The Physicians' Health Study showed a lower stroke risk among men who participated in vigorous exercise than among those who did not
- The Northern Manhattan Study—which included whites, blacks, and Hispanics and women and men in an urban setting—showed an increase in ischemic stroke risk associated with physical activity levels across all racial/ethnic and age groups and for each gender (odds ratio 0.37)
Aftermath
- Stroke is a leading cause of serious, long-term disability in the United States, according to a survey by the US Bureau of the Census
- The median time from stroke onset to arrival in an emergency department is between 3 and 6 hours, according to a study of at least 48 unique reports of prehospital delay time for patients with stroke, TIA, or stroke-like symptoms. The study included data from 17 countries, including the United States. Improved clinical outcome at 3 months was seen for patients with acute ischemic stroke when intravenous thrombolytic treatment was started within 3 hours of the onset of symptoms
- In 1999, more than 1,100,000 American adults reported difficulties with functional limitations, activities of daily living, etc., resulting from stroke
- On the basis of pooled data from 3 studies by the National Heart, Lung, and Blood Institute, the percentages of those dead within 5 years after a first stroke were as follows:
At 40 years of age or older: 47% of men and 51% of women
At 40 to 69 years of age: 32% of white men, 32% of white women, 34% of black men, and 42% of black women
At 70 years of age or older: 58% of white men, 58% of white women, 49% of black men, and 54% of black women
Cost
- The estimated direct and indirect cost of stroke for 2007 is $62.7 billion
- The mean lifetime cost of ischemic stroke in the United States is estimated at $140,048 (in 1999 dollars). This figure includes inpatient care, rehabilitation, and follow-up care necessary for lasting deficits
