Background: Stroke population-based studies in the same setting comparing time trends of rates are a gold standard method to determine the primary prevention status of stroke. Twelve years ago, we measured the stroke incidence and mortality in Matão city, Southeast of Brazil. Objective: This second Matão stroke registry study aimed to determine the time trends in the incidence, mortality, case fatality, and functional status of patients with stroke. Methods: This was a prospective, population-based study known as the Matão Preventing Stroke (MAPS). We determined all incident stroke events that occurred between August 1, 2015, and July 31, 2016. Between the periods of November 1, 2003, to October 31, 2004, and August 1, 2015, to July 31, 2016, the rates were age adjusted to the Brazilian and world population. Functional status was measured by Barthel scale 1 year after the index event. Results: We registered 81 cases of incident stroke. Demographic and cardiovascular risk factors were similar in both periods. The mean age increased by 9%, from 65.2 (95% CI 62.6–67.8) to 71.0 (95% CI 68.1–73.8) years. Between 2003–2004 and 2015–2016, the age-adjusted incidence decreased by 39% (incidence rate ratio [IRR] 0.61; 95% CI 0.46–0.79) and mortality by 50% (IRR 0.50; 95% CI 0.31–0.94). The 1-year case fatality was 26%; approximately 56% of the patients were functionally independent, while 7% had a recurrent stroke. Compared with the results of our first registry study, these outcomes did not differ significantly. Conclusion: Our findings agree with those of previous studies, showing a decline in the incidence and mortality of stroke in Brazil. Improvements in local public health care might explain these declines.

BackgroundStroke, the leading neurologic cause of death and disability, has a substantial genetic component. We previously conducted a genome-wide association study (GWAS) in four prospective studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and demonstrated that sequence variants near the NINJ2 gene are associated with incident ischemic stroke. Here, we sought to fine-map functional variants in the region and evaluate the contribution of rare variants to ischemic stroke risk.Methods and ResultsWe sequenced 196 kb around NINJ2 on chromosome 12p13 among 3,986 European ancestry participants, including 475 ischemic stroke cases, from the Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, and Framingham Heart Study. Meta-analyses of single-variant tests for 425 common variants (minor allele frequency [MAF] ≥ 1%) confirmed the original GWAS results and identified an independent intronic variant, rs34166160 (MAF = 0.012), most significantly associated with incident ischemic stroke (HR = 1.80, p = 0.0003). Aggregating 278 putatively-functional variants with MAF≤ 1% using count statistics, we observed a nominally statistically significant association, with the burden of rare NINJ2 variants contributing to decreased ischemic stroke incidence (HR = 0.81; p = 0.026).ConclusionCommon and rare variants in the NINJ2 region were nominally associated with incident ischemic stroke among a subset of CHARGE participants. Allelic heterogeneity at this locus, caused by multiple rare, low frequency, and common variants with disparate effects on risk, may explain the difficulties in replicating the original GWAS results. Additional studies that take into account the complex allelic architecture at this locus are needed to confirm these findings.

BackgroundStroke patients may have symptoms such as sleep disorders, and the incidence of frailty is much higher than that of non-stroke patients. Self-efficacy can reduce the occurrence of frailty and sleep disorders and help to maintain the health of stroke patients.ObjectiveTo investigate the relationship between sleep disorder, self-efficacy and frailty in stroke patients, and to analyse the mediating role of self-efficacy.MethodsThis study was a cross-sectional study, and 6 “stroke map” sites were selected in Shenyang from June to September 2024. A total of 924 stroke patients were included, and a structural equation model (SEM) was constructed to analyse the mediating effect of self-efficacy on sleep disorders, self-efficacy and frailty in stroke patients.ResultsThe prevalence of debilitation in stroke patients was 46.2%. Sleep disorders were positively correlated with frailty (P