This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stegmayr, B. Articles by Asplund, K. Search for Related Content PubMed PubMed Citation Articles by Stegmayr, B. Articles by Asplund, K. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Cerebrovascular disease/stroke Acute Cerebral Hemorrhage Acute Cerebral Infarction Risk Factors for Stroke

(Stroke. 2000;31:2.)
© 2000 American Heart Association, Inc.

Original Contributions

Widening Gap of Stroke Between East and West

Eight-Year Trends in Occurrence and Risk Factors in Russia and Sweden

Birgitta Stegmayr, PhD; Tatyana Vinogradova, MD; Sofia Malyutina, MD; Markku Peltonen, PhD; Yuri Nikitin, MD, PhD Kjell Asplund, MD, PhD

From the Department of Medicine, Department of Public Health and Clinical Medicine, Umeå University (Sweden) (B.S., M.P., K.A.); and Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Science, Novosibirsk, Russia (T.V., S.M., Y.N.).

Correspondence to Dr Birgitta Stegmayr, Department of Medicine, University Hospital, S-901 85 Umeå, Sweden. E-mail birgitta.stegmayr{at}medicin.umu.se

Background and Purpose—Stroke is declining in most of the western and northern European countries, whereas no such decline is seen in eastern Europe. The aim of this study was to investigate trends in stroke attack rates and 28-day case fatality and risk factor levels in Novosibirsk, Siberia, and northern Sweden during 1987–1994.

Methods—Within the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, acute stroke events and 28-day case fatality were registered in a standardized way in men and women aged 35 to 69 years. Cardiovascular risk factors were monitored in randomly selected men and women in the group aged 35 to 64 years in 1985–1986 and 1994–1995.

Results—Stroke attack rates increased significantly from 430 per 100 000 to 660 (P=0.005) in men in Novosibirsk and from 298 to 500 (P=0.02) in women. In northern Sweden, stroke attack rates varied between 244 and 303 per 100 000 in men and from 117 to 157 in women, with a small increasing trend in women (P=0.03). The mortality rates were 5 times higher in Novosibirsk, and the case fatality was significantly lower in northern Sweden (P=0.0001). The risk factor surveys showed significantly higher blood pressure, overweight, and more smoking men in Novosibirsk, while northern Sweden had higher cholesterol levels and more smoking women. Most risk factors showed stable or improving patterns over time.

Conclusions—Large differences in both attack rates and case fatality account for the large and widening gap in stroke mortality between Russia and Sweden. A higher prevalence of hypertension in Russia may explain much of the differences in stroke occurrence. In Russia, a marked increase in attack rates has occurred despite stable or improving patterns of conventional cardiovascular risk factors.

Key Words: epidemiology • mortality • risk factors • stroke

This article has been cited by other articles:

				M. Ali, S. Atula, P. M.W. Bath, J. Grotta, W. Hacke, P. Lyden, J. R. Marler, R. L. Sacco, K. R. Lees, and for the VISTA Investigators Stroke Outcome in Clinical Trial Patients Deriving From Different Countries Stroke, January 1, 2009; 40(1): 35 - 40. [Abstract] [Full Text] [PDF]

				I. Benatru, O. Rouaud, J. Durier, F. Contegal, G. Couvreur, Y. Bejot, G. V. Osseby, D. Ben Salem, F. Ricolfi, T. Moreau, et al. Stable Stroke Incidence Rates but Improved Case-Fatality in Dijon, France, From 1985 to 2004 Stroke, July 1, 2006; 37(7): 1674 - 1679. [Abstract] [Full Text] [PDF]

				A. I. Qureshi, J. F. Kirmani, M. A. Sayed, A. Safdar, S. Ahmed, R. Ferguson, L. A. Hershey, K. J. Qazi, and for the Buffalo Metropolitan Area and Erie County Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke Neurology, June 28, 2005; 64(12): 2115 - 2120. [Abstract] [Full Text] [PDF]

				J. Medin, A. Nordlund, and K. Ekberg Increasing Stroke Incidence in Sweden Between 1989 and 2000 Among Persons Aged 30 to 65 Years: Evidence From the Swedish Hospital Discharge Register Stroke, May 1, 2004; 35(5): 1047 - 1051. [Abstract] [Full Text] [PDF]

				B. Stegmayr and K. Asplund Stroke in Northern Sweden Scand J Public Health, November 1, 2003; 31(61_suppl): 60 - 69. [Abstract] [PDF]

				K. Asplund Editorial Comment--Down With the Class Society! Stroke, November 1, 2003; 34(11): 2628 - 2629. [Full Text] [PDF]

				A. Terent Trends in Stroke Incidence and 10-Year Survival in Soderhamn, Sweden, 1975-2001 Stroke, June 1, 2003; 34(6): 1353 - 1358. [Abstract] [Full Text] [PDF]

				H. Pessah-Rasmussen, G. Engstrom, I. Jerntorp, and L. Janzon Increasing Stroke Incidence and Decreasing Case Fatality, 1989-1998: A Study From the Stroke Register in Malmo, Sweden Stroke, April 1, 2003; 34(4): 913 - 918. [Abstract] [Full Text] [PDF]

				S. Koton, N. M. Bornstein, and M. S. Green Population Group Differences in Trends in Stroke Mortality in Israel Stroke, September 1, 2001; 32(9): 1984 - 1988. [Abstract] [Full Text] [PDF]

				C. Fieschi and A. Falcou Keynote address Neurology, September 1, 2001; 57(90002): S82 - 86. [Abstract] [Full Text]