The decline in midlife ischemic strokes over time is less pronounced than the decline among older adults, according to a study published in the June issue of Stroke.

Hugo J. Aparicio, M.D., from Boston University, and colleagues used data from the Framingham Study to evaluate age- and sex-adjusted 10-year incidence of ischemic stroke among participants aged 35 to 54 and ≥55 years at the start of follow-up.

The researchers found 153 incident ischemic strokes among 3,966 people beginning in 1962; 197 among 5,779 people beginning in 1971; 176 among 5,133 people beginning in 1987; and 165 among 6,964 people beginning in 1998. For ischemic strokes occurring at midlife, most were due to atherosclerotic brain infarction or cardioembolism. The risk for ischemic stroke at midlife did not significantly decline compared with the risk in the 1962 epoch (hazard ratio, 0.87; 95 percent confidence interval, 0.74 to 1.02; P trend = 0.09). In the older group, the incidence of ischemic stroke declined (hazard ratio, 0.82; 95 percent confidence interval, 0.77 to 0.88; P trend < 0.001). Based on estimates from the Framingham Stroke Risk Profile, between epochs 1 and 4, the average 10-year risk for stroke declined by 0.7 percent at midlife and 1.1 percent at older age.

"Early prevention, focused on modification of cardiovascular risk factors, is important to see sustained declines in stroke incidence and mortality at midlife," the authors write.

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