Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Daniel G. Hackam


Background: With an aging population and an increasing prevalence of therapy for atherosclerosis, it might be expected that stroke subtypes would be changing over time. Limited information exists on the ischemic stroke subtypes in adults in Canada.

Methods: Patients referred to the Urgent TIA Clinic, in London, Ontario, between 2002-2012 were included. Secular trends were analyzed using Poisson regression with spline trend function. Ischemic stroke subtype classification was validated.

Results: 3,445 consecutive patients (mean age + SD 64.8 + 14.9) were included. Cardioembolic strokes/TIAs increased from 21% in 2002 to 56% in 2012, whereas all other ischemic stroke subtypes decreased (p<0.05). Separate analysis in men and women showed similar results.

Conclusions: The decrease in atherosclerotic risk factors resulted in fewer strokes/TIAs caused by large artery atherosclerosis. On the contrary, cardioembolic strokes/TIAs have increased. This has important implications for more intensive investigation and treatment to reduce the risk of recurrent embolic stroke/TIA.