O AVC é a segunda causa principal de morte e uma das principais causas de incapacidade no mundo.[9]GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
Em 2019, 3.29 milhões de pessoas morreram em decorrência de AVC isquêmico em todo o mundo.[9]GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
Há aproximadamente 795,000 AVCs novos e recorrentes por ano nos EUA, onde é a quinta causa principal de morte e a principal causa de incapacidade.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
O AVC isquêmico responde por 87% de todos os casos de AVC nos EUA, ao passo que o AVC hemorrágico responde por cerca de 10%, e a hemorragia subaracnoide por 3%.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
A prevalência do AVC isquêmico pode ainda ser subdividida de acordo com o mecanismo fisiopatológico: aterosclerose extracraniana (10%), aterosclerose intracraniana (10%), cardioembólico (25%), infarto lacunar ([doença de pequenos vasos] 15%), etiologia indeterminada ([ou seja, criptogênica; AVC embólico de origem desconhecida] 30%) ou outras causas definidas (10%).
Em geral, o AVC isquêmico é mais comum em idosos, homens, pessoas com menor grau de escolaridade e afro-americanos e latinos/hispânicos.[11]Tsao CW, Aday AW, Almarzooq ZI, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023 Feb 21;147(8):e93-621.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001123
http://www.ncbi.nlm.nih.gov/pubmed/36695182?tool=bestpractice.com
[12]Gardener H, Sacco RL, Rundek T, et al. Race and ethnic disparities in stroke incidence in the Northern Manhattan Study. Stroke. 2020 Apr;51(4):1064-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093213
http://www.ncbi.nlm.nih.gov/pubmed/32078475?tool=bestpractice.com
[13]Howard G, Moy CS, Howard VJ, et al. Where to focus efforts to reduce the Black-White disparity in stroke mortality: incidence versus case fatality? Stroke. 2016 Jul;47(7):1893-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927373
http://www.ncbi.nlm.nih.gov/pubmed/27256672?tool=bestpractice.com
[14]Xiuyun W, Qian W, Minjun X, et al. Education and stroke: evidence from epidemiology and Mendelian randomization study. Sci Rep. 2020 Dec 3;10(1):21208.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713498
http://www.ncbi.nlm.nih.gov/pubmed/33273579?tool=bestpractice.com
[15]Cruz-Flores S, Rabinstein A, Biller J, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Jul;42(7):2091-116.
https://www.ahajournals.org/doi/full/10.1161/STR.0b013e3182213e24
http://www.ncbi.nlm.nih.gov/pubmed/21617147?tool=bestpractice.com
No entanto, as taxas de trombose venosa cerebral são maiores nas mulheres mais jovens, sendo a contracepção oral e a gravidez/puerpério os principais fatores de risco.[8]Saposnik G, Bushnell C, Coutinho JM, et al. Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. Stroke. 2024 Mar;55(3):e77-90.
https://www.doi.org/10.1161/STR.0000000000000456
http://www.ncbi.nlm.nih.gov/pubmed/38284265?tool=bestpractice.com
[16]Khan M, Arauz A, Uluduz D, et al. Predictors of mortality and functional outcome in pregnancy and puerperium-related cerebral venous thrombosis. Cerebrovasc Dis. 2023;52(4):393-400.
https://www.doi.org/10.1159/000527155
http://www.ncbi.nlm.nih.gov/pubmed/36566747?tool=bestpractice.com
[17]Kashkoush AI, Ma H, Agarwal N, et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci. 2017 May;39:9-15.
https://www.doi.org/10.1016/j.jocn.2017.02.046
http://www.ncbi.nlm.nih.gov/pubmed/28274514?tool=bestpractice.com
Tanto a incidência geral de AVC´s padronizada por idade como a mortalidade por AVC´s têm diminuído nas últimas décadas nos países de alta renda, provavelmente devido a uma prevenção primária efetiva e à melhora do tratamento durante a fase aguda do AVC, embora haja evidências de aumento da incidência entre adultos jovens.[10]Seth SM, Aaron WA, Zaid IA, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Jan 24;149:e347-913.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209
[18]Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018 Sep;17(9):790-801.
http://www.ncbi.nlm.nih.gov/pubmed/30129475?tool=bestpractice.com
[19]Seminog OO, Scarborough P, Wright FL, et al. Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. BMJ. 2019 May 22;365:l1778.
https://www.bmj.com/content/365/bmj.l1778.long
http://www.ncbi.nlm.nih.gov/pubmed/31122927?tool=bestpractice.com
[20]Lanas F, Seron P. Facing the stroke burden worldwide. Lancet Glob Health. 2021 Mar;9(3):e235-6.
https://www.doi.org/10.1016/S2214-109X(20)30520-9
http://www.ncbi.nlm.nih.gov/pubmed/33422188?tool=bestpractice.com
Por outro lado, a incidência e a mortalidade por AVC´s nos países de baixa e média rendas aumentaram.[21]Pandian JD, Gall SL, Kate MP, et al. Prevention of stroke: a global perspective. Lancet. 2018 Oct 6;392(10154):1269-78.
http://www.ncbi.nlm.nih.gov/pubmed/30319114?tool=bestpractice.com
[22]Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017 Feb 21;135(8):759-71.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.025250
http://www.ncbi.nlm.nih.gov/pubmed/28052979?tool=bestpractice.com
[23]Ezejimofor MC, Chen YF, Kandala NB, et al. Stroke survivors in low- and middle-income countries: a meta-analysis of prevalence and secular trends. J Neurol Sci. 2016 May 15;364:68-76.
https://www.doi.org/10.1016/j.jns.2016.03.016
http://www.ncbi.nlm.nih.gov/pubmed/27084220?tool=bestpractice.com
Em 2019, a taxa de mortalidade relacionada a AVC´s padronizada por idade foi 3.6 vezes maior no grupo de baixa renda do Banco Mundial do que no grupo de alta renda do Banco Mundial.[9]GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
Em 2021, a Oceania e as regiões sudeste e central da Ásia tiveram as maiores taxas de mortalidade por AVC´s em geral.[9]GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820.
https://www.doi.org/10.1016/S1474-4422(21)00252-0
http://www.ncbi.nlm.nih.gov/pubmed/34487721?tool=bestpractice.com
O AVC é a principal causa de morte na China.[22]Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation. 2017 Feb 21;135(8):759-71.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.116.025250
http://www.ncbi.nlm.nih.gov/pubmed/28052979?tool=bestpractice.com