Article Text

UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the General Practice Research Database
  1. Sally Lee1,
  2. Anna C E Shafe1,
  3. Martin R Cowie2
  1. 1MAPOR, Boehringer Ingelheim Ltd, Bracknell, Berkshire, UK
  2. 2National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Professor M R Cowie; m.cowie{at}


Objectives Stroke is a major cause of morbidity and mortality. This study aimed to investigate secular trends in stroke across the UK.

Design This study aimed to investigate recent trends in the epidemiology of stroke in the UK. The study was a time-trend analysis from 1999 to 2008 within the UK General Practice Research Database. Outcome measures were incidence and prevalence of stroke, stroke mortality, rate of secondary cardiovascular events, and prescribing of pharmacological therapy for primary and secondary prevention of cardiovascular disease.

Results The study cohort included 32 151 patients with a first stroke. Stroke incidence fell by 30%, from 1.48/1000 person-years in 1999 to 1.04/1000 person-years in 2008 (p<0.001). Stroke prevalence increased by 12.5%, from 6.40/1000 in 1999 to 7.20/1000 in 2008 (p<0.001). 56-day mortality after first stroke reduced from 21% in 1999 to 12% in 2008 (p<0.0001). Prescribing of drugs to control cardiovascular risk factors increased consistently over the study period, particularly for lipid lowering agents and antihypertensive agents. In patients with atrial fibrillation, use of anticoagulants prior to first stroke did not increase with increasing stroke risk.

Conclusion Stroke incidence in the UK has decreased and survival after stroke has improved in the past 10 years. Improved drug treatment in primary care is likely to be a major contributor to this, with better control of risk factors both before and after incident stroke. There is, however, scope for further improvement in risk factor reduction in high-risk patients with atrial fibrillation.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).

  • To cite: Lee S, Shafe ACE, Cowie MR. UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the General Practice Research Database. BMJ Open 2011;1:e000269. doi:10.1136/bmjopen-2011-000269

  • Funding The study was funded by Boehringer Ingelheim Ltd.

  • Competing interests MRC provides consultancy advice to a number of pharmaceutical companies that might have an interest in the submitted work in the previous 3 years, including a consultancy contract to advise the Boehringer Ingelheim epidemiology team on CV analyses. SL and AS are employees of Boehringer Ingelheim Ltd, who market a number of cardiovascular therapies and might have an interest in the submitted work in the previous 3 years; SL and AS received no support from any other organisation for the submitted work.

  • Ethics approval The protocol for the study has been approved by the Independent Scientific Advisory Committee at the Medicines and Healthcare products Regulatory Agency.

  • Contributors AS and SL performed the data extraction and data analyses, and helped write the manuscript. MC advised regarding the study design and data analyses, and wrote the manuscript. He is the guarantor for the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.