Risk factors, outcome, and treatment in subtypes of ischemic stroke - The German Stroke Data Bank

Background and Purpose-Data on risk factors for etiologic subtypes of ische mic stroke are still scant. The aim of this study was to characterize strok e subtypes regarding risk factor profile, outcome, and current treatment st rategies. Methods-We analyzed data from 5017 patients with acute ischemic stroke (42. 4% women, aged 65.9 +/- 14.1 years) who were enrolled in a large multicente r hospital-based stroke data bank. Standardized data assessment and stroke subtype classification were used by all centers. Results-Sex and age distribution, major risk factors and comorbidities, rec urrent stroke, treatment strategies, and outcome were all unevenly distribu ted among stroke subtypes (P <0.001, respectively). Cardioembolism, the mos t frequent etiology of stroke (25.6%), was particularly common in the elder ly (those aged > 70 years) and associated with an adverse outcome, a low ra te of early stroke recurrence, and frequent use of thrombolytic therapy and intravenous anticoagulation. Large-artery atherosclerosis (20.9%), the mos t common cause of stroke in middle-aged patients (those aged 45 to 70 years ), showed the highest male preponderance, highest rate of early stroke recu rrence, and highest prevalence of previous transient ischemic attack, curre nt smoking, and daily alcohol consumption among all subtypes. The highest p revalence of hypertension, diabetes mellitus, hypercholesterolemia, and obe sity was found in small-vessel disease (20.5%), which, in turn, was associa ted with the lowest,stroke severity and mortality. Conclusions-Our results foster the concept of ischemic stroke as a polyetio logic disease with marked differences between subtypes regarding risk facto rs and outcome. Therefore, studies involving risk factors of ischemic strok e should differentiate between etiologic stroke subtypes.