2023-06-18 02:38:51
Alerts in the age range from 41 to 50 have grown 49.46% in three years.
Urgent action protocols to treat an acute stroke, such as the Cicat (Registre Codi Ictus Catalunya), have helped to bring out more cases related to this pathology each year (also in people youths, under 50 years of age), which has allowed them to be treated more quickly. Of course, this more efficient detection does not mean that the incidence has increased on a general scale. In Catalonia, for example, there are between 14,000 and 15,000 cases per year (in Spain there are about 120,000, according to figures from the Spanish Society of Neurology). An increase is observed in developing countries as risk factors increase, such as obesity.
The data shows that the activation of the stroke code has been increasing over the years. In Catalonia, in the age range of 41 to 50 years, there have been 279 alerts in 2018 to 417 in 2021 (49.46% more), according to figures from the Agència de Qualitat i Avaluació Sanitàries de Catalunya ( HERE). In the group from 51 to 60 years old, the increase has been from 621 notices in 2018 to 811 in 2021 ((30.6%), while from 61 to 70 it has gone from 954 to 1,267 (32, 81%) and from 71 to 80 from 1,433 to 1,886 (31.61%).It should be noted that the increase in registries such as Cicat “does not necessarily mean that the incidence of stroke is growing, but rather that the registry is more efficient, identifying more and better the serious cases”, he explains to The vanguard Marc Ribó, interventional neurologist at the Vall d’Hebron hospital. He defends that there was no significant increase in cases during the pandemic either. “There was a lot of attention to see if the covid could have increased the incidence, and it seems that this is not the case, not even in the first months.”
There are several reasons that would explain this growth in activations of the stroke code, a pathology that is the first cause of mortality in women and the third in men. Among these, “that the general knowledge of both the population and non-specialist doctors regarding stroke is increasing,” says Dr. Ángel Chamorro, head of the stroke unit at the Hospital Clínic. “Before – he continues – it seemed that the only infarction you could have was a myocardial infarction. However, now everyone, more or less, is aware that a stroke is an emergency and that there are transitory symptoms that may be due to a cerebral vascular problem”. In his opinion, more frequent and widespread use of magnetic resonance imaging has also made it possible to discover “many cerebral irrigation problems that were previously undetected.” Chamorro stresses that, indeed, the incidence has not increased in general in recent years (the Clínic treats about 1,000 cases per year), but points out that some international registries (from countries such as the United States, Denmark or France) are detecting a slight upturn of cases in people under 50 years of age. One possible explanation would be the increase in some of the risk factors in this group, which accounts for a small percentage (10%) of the total global incidence. “Higher rates of type II diabetes, hypercholesterolemia are being reported; the number of obese young people is increasing; there is also an increase in the consumption of illicit drugs that generate a lot of vasoconstriction of the arteries”, reflects Chamorro, who acknowledges that in 30% of the cases that affect this age group, it is unknown what caused them.
Even in recent years, he adds, new factors have emerged that have an increasingly prominent weight in the risk attributable to the causes of stroke and that affect all age groups. “To hypertension, diabetes, hypercholesterolemia, smoking or sedentary lifestyle, now we add air pollution, which has a very important weight. And a poison damages whoever is exposed to it, no matter how old they are.”
Beyond the slight increase that some registries detect in people under 50 years of age, on a global scale, the number of strokes is decreasing “because there are primary prevention plans that seem to work,” Chamorro points out. But there is the paradox that in developing countries the incidence increases. The explanation? The importation of bad habits. “If you don’t eat a lot, you won’t have obesity or hypercholesterolemia. But if you go from being hungry to having the possibility of having access to food in a developing country, it is possible that you eat poorly, leading a more unhealthy life”, concludes Chamorro. The global incidence is declining, but it is growing in developing countries due to bad habits.
“The time factor is crucial in forecasting”
Registries such as the Cicat de Catalunya are allowing a very substantial improvement in the approach to stroke cases. In this sense, the performance times are being shortened. “The time factor is crucial in the forecast. We have treatments, but these have a time window in which they can be applied,” says Dr. Chamorro. “All these indicators have improved a lot in recent years,” adds neurologist Marc Ribó. “All these times have been shortening while treatment coverage has increased. Catalonia, for example, which is a world benchmark, has one of the highest rates in the world of patients treated over the total population”, he adds. Before, he continues, there was a big difference between the population of the Barcelona area and the rest of the citizens. “People who live in the capital, close to the large referral centers, were more likely to receive these treatments and quickly. But, now, what is being achieved is to reduce these differences, equalizing the access and the time to start the treatment”. Josep Fita
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