Skip to main content
SpringerLink
Log in

Stroke seasonality associations with subtype, etiology and laboratory results in the Ludwigshafen Stroke Study (LuSSt)

  • CARDIOVASCULAR DISEASE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Data on seasonal differences in stroke incidence are conflicting. Little is known about seasonal variability in etiological stroke subtypes and population-based data on possible trigger factors are lacking. The Ludwigshafen Stroke Study is a prospective population-based stroke registry. All residents of the city of Ludwigshafen who suffer from acute stroke or TIA are registered. Patients with first-ever stroke (FES) were included for the present analysis. Between January 1, 2006 and December 31st, 2010, 1,779 patients (age 71.7 ± 13.4 years (mean + standard deviation; 897 (50.4 %) women) suffered a FES. Incidence for FES was lowest in summer (reference) with significantly higher rates in winter (rate ratio (RR) 1.20, 95 % confidence interval (CI) 1.05–1.37) and spring (RR 1.21 95 % CI 1.06–1.38). First-ever ischemic stroke (FEIS) was more common in winter (RR 1.16, 95 %CI 1.01–1.34) and first-ever intracerebral haemorrhage (FE-ICH) was more frequent in spring (RR 2.0, 95 %CI 1.24–3.22) than in summer. In FES, systolic and diastolic blood pressure on admission (SBP/DBP) showed significant variation with lowest values in summer (SBP: p = 0.02; DBP p = 0.05). In subtypes of FEIS, cardioembolism tended to be more common in winter (p = 0.14). There were no differences in risk factor prevalence between seasons. Leukocyte count on admission was lowest in summer (8.2 ± 1.4/μl) and highest in winter (8.9 ± 1.9/μl; p = 0.008). The hematocrit showed a similar trend (p = 0.06). Our data show higher incidence rates for FES in winter and spring, for FEIS in winter and for FE-ICH in spring. Variations in blood pressure on admission and leukocyte counts were associated with these findings and may possibly contribute to seasonal stroke variability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Giroud M, Beuriat P, Vion P, D’Athis PH, Dusserre L, Dumas R. Stroke in a French prospective population study. Neuroepidemiology. 1989;8(2):97–104.

    Article  PubMed  CAS  Google Scholar 

  2. Jakovljevic D, Salomaa V, Sivenius J, Tamminen M, Sarti C, Salmi K, et al. Seasonal variation in the occurrence of stroke in a Finnish adult population. The FINMONICA Stroke Register. Finnish monitoring trends and determinants in cardiovascular disease. Stroke. 1996;27(10):1774–9.

    Article  PubMed  CAS  Google Scholar 

  3. Ricci S, Celani MG, Vitali R, La Rosa F, Righetti E, Duca E. Diurnal and seasonal variations in the occurrence of stroke: a community-based study. Neuroepidemiology. 1992;11(2):59–64.

    Article  PubMed  CAS  Google Scholar 

  4. Turin TC, Kita Y, Murakami Y, Rumana N, Sugihara H, Morita Y, et al. Higher stroke incidence in the spring season regardless of conventional risk factors: Takashima Stroke Registry, Japan, 1988–2001. Stroke. 2008;39(3):745–52. doi:10.1161/STROKEAHA.107.495929.

    Article  PubMed  Google Scholar 

  5. Wang H, Sekine M, Chen X, Kagamimori S. A study of weekly and seasonal variation of stroke onset. Int J Biometeorol. 2002;47(1):13–20. doi:10.1007/s00484-002-0147-x.

    Article  PubMed  Google Scholar 

  6. Khan FA, Engstrom G, Jerntorp I, Pessah-Rasmussen H, Janzon L. Seasonal patterns of incidence and case fatality of stroke in Malmo, Sweden: the STROMA study. Neuroepidemiology. 2005;24(1–2):26–31. doi:10.1159/000081046.

    Article  PubMed  Google Scholar 

  7. Rothwell PM, Wroe SJ, Slattery J, Warlow CP. Is stroke incidence related to season or temperature? The Oxfordshire Community Stroke Project. Lancet. 1996;347(9006):934–6.

    Article  PubMed  CAS  Google Scholar 

  8. Wang Y, Levi CR, Attia JR, D’Este CA, Spratt N, Fisher J. Seasonal variation in stroke in the Hunter Region, Australia: a 5-year hospital-based study, 1995–2000. Stroke. 2003;34(5):1144–50. doi:10.1161/01.STR.0000067703.71251.B6.

    Article  PubMed  Google Scholar 

  9. Mavri A, Guzic-Salobir B, Salobir-Pajnic B, Keber I, Stare J, Stegnar M. Seasonal variation of some metabolic and haemostatic risk factors in subjects with and without coronary artery disease. Blood Coagul Fibrinolysis. 2001;12(5):359–65.

    Article  PubMed  CAS  Google Scholar 

  10. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation. 2006;114(17):1863–72. doi:10.1161/CIRCULATIONAHA.105.596189.

    Article  PubMed  Google Scholar 

  11. Woodhouse PR, Khaw KT, Plummer M. Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens. 1993;11(11):1267–74.

    Article  PubMed  CAS  Google Scholar 

  12. Palm F, Urbanek C, Rose S, Buggle F, Bode B, Hennerici MG, et al. Stroke incidence and survival in Ludwigshafen am Rhein, Germany: the Ludwigshafen Stroke Study (LuSSt). Stroke. 2010;41(9):1865–70. doi:10.1161/STROKEAHA.110.592642.

    Article  PubMed  Google Scholar 

  13. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976;54(5):541–53.

    PubMed  CAS  Google Scholar 

  14. Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, Hennerici MG, et al. Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry. Cerebrovasc Dis. 2012;33(1):69–75. doi:10.1159/000333417.

    Article  PubMed  CAS  Google Scholar 

  15. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.

    Article  PubMed  Google Scholar 

  16. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005;58(5):688–97. doi:10.1002/ana.20617.

    Article  PubMed  Google Scholar 

  17. Balkau B. The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes Metab. 2000;26(4):282–6.

    PubMed  CAS  Google Scholar 

  18. Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46(6):660–2.

    Article  PubMed  CAS  Google Scholar 

  19. Kynast-Wolf G, Hammer GP, Muller O, Kouyate B, Becher H. Season of death and birth predict patterns of mortality in Burkina Faso. Int J Epidemiol. 2006;35(2):427–35. doi:10.1093/ije/dyi150.

    Article  PubMed  Google Scholar 

  20. Miettinen O, Nurminen M. Comparative analysis of two rates. Stat Med. 1985;4(2):213–26.

    Article  PubMed  CAS  Google Scholar 

  21. Brennan PJ, Greenberg G, Miall WE, Thompson SG. Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed). 1982;285(6346):919–23.

    Article  CAS  Google Scholar 

  22. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.

    Article  PubMed  CAS  Google Scholar 

  23. Collins R, Peto R, Godwin J, MacMahon S. Blood pressure and coronary heart disease. Lancet. 1990;336(8711):370–1.

    Article  PubMed  CAS  Google Scholar 

  24. Kunes J, Tremblay J, Bellavance F, Hamet P. Influence of environmental temperature on the blood pressure of hypertensive patients in Montreal. Am J Hypertens. 1991;4(5 Pt 1):422–6.

    Article  PubMed  CAS  Google Scholar 

  25. Alperovitch A, Lacombe JM, Hanon O, Dartigues JF, Ritchie K, Ducimetiere P, et al. Relationship between blood pressure and outdoor temperature in a large sample of elderly individuals: the Three-City study. Arch Intern Med. 2009;169(1):75–80. doi:10.1001/archinternmed.2008.512.

    Article  PubMed  Google Scholar 

  26. Urch B, Silverman F, Corey P, Brook JR, Lukic KZ, Rajagopalan S, et al. Acute blood pressure responses in healthy adults during controlled air pollution exposures. Environ Health Perspect. 2005;113(8):1052–5.

    Article  PubMed  Google Scholar 

  27. Fletcher RD, Amdur RL, Kolodner R, McManus C, Jones R, Faselis C, et al. Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository. Circulation. 2012;125(20):2462–8. doi:10.1161/CIRCULATIONAHA.111.029983.

    Article  PubMed  Google Scholar 

  28. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147–52. doi:10.1161/01.STR.0000124122.71702.64.

    Article  PubMed  Google Scholar 

  29. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279(18):1477–82.

    Article  PubMed  CAS  Google Scholar 

  30. Coller BS. Leukocytosis and ischemic vascular disease morbidity and mortality: is it time to intervene? Arterioscler Thromb Vasc Biol. 2005;25(4):658–70. doi:10.1161/01.ATV.0000156877.94472.a5.

    Article  PubMed  CAS  Google Scholar 

  31. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351(25):2611–8. doi:10.1056/NEJMoa041747.

    Article  PubMed  CAS  Google Scholar 

  32. Nardi K, Milia P, Eusebi P, Paciaroni M, Caso V, Agnelli G. Admission leukocytosis in acute cerebral ischemia: influence on early outcome. J Stroke Cerebrovasc Dis. 2011;. doi:10.1016/j.jstrokecerebrovasdis.2011.04.015.

    PubMed  Google Scholar 

  33. Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease—the Framingham study: a 34-year follow-up. Am Heart J. 1994;127(3):674–82.

    Article  PubMed  CAS  Google Scholar 

  34. Thirup P. Haematocrit: within-subject and seasonal variation. Sports Med. 2003;33(3):231–43.

    Article  PubMed  Google Scholar 

  35. Sebok MA, Notari EP, Chambers LA, Benjamin RJ, Eder AF. Seasonal temperature variation and the rate of donor deferral for low hematocrit in the American Red Cross. Transfusion. 2007;47(5):890–4. doi:10.1111/j.1537-2995.2007.01206.x.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Data analysis was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG; GR1102/6-1). LuSSt is part of the German Competence Network Stroke.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurology, Städtisches Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen a. Rh., Germany

    Frederick Palm, Michael Dos Santos, Christian Urbanek, Matthias Greulich, Kathrin Zimmer & Armin Jürgen Grau

  2. Institute of Public Health, University of Heidelberg, Heidelberg, Germany

    Anton Safer & Heiko Becher

Authors
  1. Frederick Palm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Urbanek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias Greulich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kathrin Zimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anton Safer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Armin Jürgen Grau
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heiko Becher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederick Palm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palm, F., Santos, M.D., Urbanek, C. et al. Stroke seasonality associations with subtype, etiology and laboratory results in the Ludwigshafen Stroke Study (LuSSt). Eur J Epidemiol 28, 373–381 (2013). https://doi.org/10.1007/s10654-013-9772-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-013-9772-4

Keywords

Search

Navigation