<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40">  <head> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 9"> <meta name=Originator content="Microsoft Word 9"> <link rel=File-List href="./ZIEK03_files/filelist.xml"> <link rel=Edit-Time-Data href="./ZIEK03_files/editdata.mso"> <!--[if !mso]> <style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style> <![endif]--> <title>Ziek03</title> <style> <!--  /* Font Definitions */ @font-face 	{font-family:"Lucida Console"; 	panose-1:2 11 6 9 4 5 4 2 2 4; 	mso-font-charset:0; 	mso-generic-font-family:modern; 	mso-font-pitch:fixed; 	mso-font-signature:-2147482993 6144 0 0 31 0;}  /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal 	{mso-style-parent:""; 	margin:0cm; 	margin-bottom:.0001pt; 	mso-pagination:widow-orphan; 	font-size:12.0pt; 	font-family:"Times New Roman"; 	mso-fareast-font-family:"Times New Roman";} a:link, span.MsoHyperlink 	{color:blue; 	text-decoration:underline; 	text-underline:single;} a:visited, span.MsoHyperlinkFollowed 	{color:purple; 	text-decoration:underline; 	text-underline:single;} p 	{font-size:12.0pt; 	font-family:"Times New Roman"; 	mso-fareast-font-family:"Times New Roman";} @page Section1 	{size:595.3pt 841.9pt; 	margin:70.85pt 70.85pt 70.85pt 70.85pt; 	mso-header-margin:35.4pt; 	mso-footer-margin:35.4pt; 	mso-paper-source:0;} div.Section1 	{page:Section1;} --> </style> <!--[if gte mso 9]><xml>  <o:shapedefaults v:ext="edit" spidmax="1027"/> </xml><![endif]--><!--[if gte mso 9]><xml>  <o:shapelayout v:ext="edit">   <o:idmap v:ext="edit" data="1"/>  </o:shapelayout></xml><![endif]--> <meta name=Template content="C:\Program Files\Microsoft Office\Office\html.dot"> </head>  <body bgcolor=white lang=EN-GB link=blue vlink=purple style='tab-interval:36.0pt'>  <div class=Section1>  <p align=center style='text-align:center'><span style='font-size:10.0pt; font-family:Arial;color:red'>Morbidat&nbsp; &nbsp;:&nbsp;Morbidit : Situation actuelle<br> </span><span style='font-size:7.5pt;font-family:Arial;color:red'>Copyright  1998 Institut Scientifique de la Sant Publique.<br> Section Epidmiologie. All rights reserved.<br> En collaboration avec les Communauts Franaise et Flamande de Belgique.<o:p></o:p></span></p>  <p align=center style='text-align:center'><img width=513 height=8 id="_x0000_i1025" src="..\..\GIFS\MB1.GIF"><a name=TOP></a></p>  <p align=center style='text-align:center'><b><span style='font-size:13.5pt; font-family:Arial;color:green'>MORBIDITES: ETAT ACTUEL DES CONNAISSANCES<o:p></o:p></span></b></p>  <p align=center style='text-align:center'><b><span style='font-size:13.5pt; font-family:Arial;color:green'>AFFECTIONS CEREBRO-VASCULAIRES<o:p></o:p></span></b></p>  <p align=center style='text-align:center'><img width=513 height=8 id="_x0000_i1026" src="..\..\GIFS\MB1.GIF"></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Date de mise  jour: 10/96<o:p></o:p></span></p>  <p><b><span style='font-family:Arial;color:green'>DEFINITION - SYMPTOMES - DETERMINANTS</span></b><span style='font-family:Arial;color:green'> <o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>CLASSIFICATION ET DEFINITIONS<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Dans la classification ICD, les affections vasculaires crbraux se divisent comme suit:<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 430: Hmorragie sous-arachnodienne.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 431: Hmorragie crbrale.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 432: Hmorragies intracrniennes autres et sans prcision.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 433: Occlusion et stnose des artres prcrbrales.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>CIN 434:Occlusion des artres crbrales, parmi laquelles thrombose crbrale et embolie crbrale.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span lang=NL-BE style='font-size:10.0pt; font-family:Arial;mso-ansi-language:NL-BE'>ICD 435: Ischmie crbrale transitoire.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 436: Maladies crbro-vasculaires aigus mais mal dfinies, parmi lesquelles apoplexie.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 437: Maladies crbro-vasculaires, autres et mal dfinies.<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>ICD 438: Squelles des maladies crbro-vasculaires.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>L'OMS (2) dfinit l'accident vasculaire crbral (AVC) comme l'apparition brutale d'un dficit neurologique suite  une pathologie focale (ou globale) de la fonction crbrale. Il se manifeste pendant une dure suprieure ou gale  24 heures ou mne  la mort pendant cette priode et il y a absence apparente de toute autre pathologie vasculaire.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>L'ischmie crbrale transitoire ou l'accident ischmique transitoire (AIT) est dfini comme une insuffisance circulatoire temporaire menant  des symptmes neurologiques, qui subissent une rgression avant les 24 heures.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>SYMPTOMES ET DETERMINANTS (3)<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>L'apparition subite d'un dficit neurologique peut varier d'une hmiplgie totale avec coma, jusqu' des troubles neurologiques peu perceptibles. Le cours de l'volution varie de quelques secondes, minutes ou heures jusque plusieurs jours.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Lors d'une embolie ou d'une rupture d'un anvrisme crbral, l'affection se caractrise gnralement par un dbut brutal et le dficit neurologique atteint presque immdiatement son extension maximale.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>L'AVC  cause d'une thrombose se caractrise galement par un commencement brutal mais la suite est plus chelonne et s'tale sur une priode de plusieurs jours. Pendant celle-ci des dficits nerveux se dveloppant brutalement peuvent apparatre.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Lors d'une hmorragie crbrale, les symptmes se manifestent de faon plus discrte et s'talent sur une priode de minutes ou d'heures. </span><span lang=NL-BE style='font-size: 10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>Le dficit est en gnral irrversible.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Si le patient survit un AVC, l'volution tend  une stabilisation et une rcupration partielle se manifeste qui peut durer des semaines ou des mois.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Dans 13 % des cas, une rcidive se rvle durant la premire anne et par aprs, sa frquence va en augmentant annuellement de 5 %. Le risque cumulatif de l'AVC rcidivant est lev pendant une priode de cinq ans et se montre chez un tiers jusque la moiti des patients ayant subi pralablement un AVC (4).<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>A part l'ge et le sexe, l'on considre les facteurs suivants comme dterminants les plus importants (3,5):<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>1. Hypertension pour les AVC tant ischmiques qu'hmorragiques;<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>2. Antcdents des AVC;<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>3. Certaines affections cardiaques, comme l'insuffisance coronarienne, fibrillation auriculaire, hypertrophie et insuffisance ventriculaire;<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>4. Diabte, dont l'importance est infrieure  celle des dterminants dj cits;<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>5. Les habitudes tabagiques influencent l'incidence de l'AVC ischmique et hmorragique de faon ngative;<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>6. Une cholestrolmie leve influence l'incidence de faon ngative. <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Les enregistrements obtenus par un rseau de mdecins vigies durant les annes 1988-1989 mettent ces diffrents facteurs en vidence (tableau 1).<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 1</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Facteurs personnels de risque chez les patients atteints d'un AIT et chez ceux atteints d'un AVC (1).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=491 style='width:368.25pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="31%" colspan=2 valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>AIT</span><span lang=NL-BE   style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>   <td width="31%" colspan=2 valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>AVC</span><span lang=NL-BE   style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span lang=NL-BE style='font-size:10.0pt;font-family:Arial;mso-ansi-language:   NL-BE'>Facteurs de risque</span><span lang=NL-BE style='mso-ansi-language:   NL-BE'><o:p></o:p></span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>N=118*</span><span   lang=NL-BE style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>%</span><span lang=NL-BE   style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>N=269*</span><span   lang=NL-BE style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span lang=NL-BE style='font-size:   10.0pt;font-family:Arial;mso-ansi-language:NL-BE'>%</span><span lang=NL-BE   style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span lang=NL-BE style='font-size:10.0pt;font-family:Arial;mso-ansi-language:   NL-BE'>Hypertension</span><span lang=NL-BE style='mso-ansi-language:NL-BE'><o:p></o:p></span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>60</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>50,8</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>150</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>55,8</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Hyperlipidmie</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>30</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>25,4</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>73</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>27,1</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Antcdents d'AVC</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>42</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>35,6</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>84</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>31,2</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Antcdents vasculaires</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>51</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>43,2</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>80</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>29,7</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Diabte</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>14</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>11,9</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>33</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>12,3</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Fumeur</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>21</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>17,8</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>43</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>16,0</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Ex-fumeur</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>19</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>16,1</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>67</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>24,9</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Autre risque**</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>15</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>12,7</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>34</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>12,6</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Aucun risque</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>10</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>8,5</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>36</span></p>   </td>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>13,4</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>* patients pour lesquels cette information est disponible<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>** p. ex. obsit, insuffisance rnale<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>BIBLIOGRAPHIE<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>1. Van Casteren V and Van der Veken J. La morbidit en Belgique en 1988-1989.Institut d'Hygine et d'Epidmiologie. Bruxelles. Socit Scientifique de Mdecine Gnrale, 1990; <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>2. WHO MONICA Project, Principal Investigators. - Montitoring trends and determinants in cardiovascular disease: a major international collaboration. J. clin. Epidemiol. 1988; 41: 105-114.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>3. Harrison's Principles of Internal Medecine. 10th Ed. McGraw-Hill, 1983;-2212. <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>4. Burt M.J., Halliday J.W., Powell L.W. - Iron and coronary heart disease. Br Med J 1993; 307: 575-576.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>5. Marmot M.G., Poulter N.R. - Primary Prevention of Stroke. Lancet 1992; 339: 344-347.<o:p></o:p></span></p>  <p><span style='font-family:Arial;color:green'>&nbsp;<o:p></o:p></span></p>  <p><b><span style='font-family:Arial;color:green'>DONNEES EPIDEMIOLOGIQUES</span></b><span style='font-family:Arial;color:green'> <o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>EPIDEMIOLOGIE<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><span style='font-family:Arial'>* Incidence<o:p></o:p></span></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Egalement pour cette investigation les rsultats provenant du rseau des mdecins vigies, octobre 1988 - octobre 1989, ont t utiliss. Ce rseau a enregistr tant les donnes concernant les AIT que celles concernant les ACV.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>AIT: L'incidence augmente rgulire avec l'ge, aussi bien chez les hommes que chez les femmes.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Le tableau 2 montre l'incidence globale des AIT et l'incidence spcifique pour les hommes et les femmes. La diffrence entre les deux sexes ne parut pas significative (P &gt; 0,05).<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 2</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Incidence des TIA en Belgique, selon l'enregistrement des mdecins vigies en 1988-1989 (1).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=340 style='width:255.0pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="67%" valign=top style='width:67.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence pour 10.000   habitants</span></p>   </td>   <td width="33%" valign=top style='width:33.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>10,2 (+/- 1,8)</span></p>   </td>  </tr>  <tr>   <td width="67%" valign=top style='width:67.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre attendu de cas par   an</span></p>   </td>   <td width="33%" valign=top style='width:33.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>10.014</span></p>   </td>  </tr>  <tr>   <td width="67%" valign=top style='width:67.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence pour 10.000   hommes</span></p>   </td>   <td width="33%" valign=top style='width:33.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>9,0 (+/- 2,4)</span></p>   </td>  </tr>  <tr>   <td width="67%" valign=top style='width:67.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence pour 10.000   femmes</span></p>   </td>   <td width="33%" valign=top style='width:33.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>11,0 (+/- 2,6)</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>AVC: L'incidence des AVC augmente avec l'ge, de 3 par 10.000 personnes n'ayant pas atteint 60 ans jusque 300 par 10.000 au-del les 80 ans. La mme figure montre que dans tous les groupes d'ge l'incidence en 1988-1989 fut infrieure ou similaire  celle enregistre en 1984, et ce tant chez les hommes que chez les femmes.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Le tableau 3.3 montre l'incidence globale des AVC et l'incidence spcifique chez les hommes et les femmes, durant l'anne 1984 et la priode 1988-1989.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Il n'y avait pas de diffrence significative entre les deux priodes de l'investigation concernant l'incidence globale (P &gt; 0,05). Concernant l'incidence spcifique, la mme conclusion fut valable pour les deux priodes (P &gt; 0,05) (1).<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 3</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Incidence des AVC en Belgique, selon l'enregistrement des mdecins vigies en 1984 et en 1988-1989 (1).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=453 style='width:339.75pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="50%" valign=top style='width:50.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1984</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1988-1989</span></p>   </td>  </tr>  <tr>   <td width="50%" valign=top style='width:50.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence /10.000   habitants</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>26,2 +/- 2,6</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>23,0 +/- 2,7</span></p>   </td>  </tr>  <tr>   <td width="50%" valign=top style='width:50.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre attendu de cas par   an</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>22.371</span></p>   </td>  </tr>  <tr>   <td width="50%" valign=top style='width:50.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence pour 10.000   hommes</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>25,7 +/- 4,3</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>20,8 +/- 3,6</span></p>   </td>  </tr>  <tr>   <td width="50%" valign=top style='width:50.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence pour 10.000   femmes</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>26,4 +/- 4,2</span></p>   </td>   <td width="25%" valign=top style='width:25.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>24,9 +/- 3,9</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><span style='font-family:Arial'>* Mortalit et rtablissement<o:p></o:p></span></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>A tous les patients encore en vie 24 heures aprs un AVC, un formulaire de suivi fut envoy aprs une semaine (1). Pour ceux toujours en vie aprs une semaine, un second formulaire de suivi fut envoy aprs huit semaines. Le tableau 3.4 montre qu'aprs 8 semaines presque 50 % des patients sont dcds.<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 4</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Nombre de dcs des patients ACV dans les 24 heures, aprs 1 semaine et aprs 8 semaines (1).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=501 style='width:375.75pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>&gt; 24h (N=210*)</span></p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1 semaine (N=210*)</span></p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>8 semaines (N=210*)</span></p>   </td>  </tr>  <tr>   <td width="15%" valign=top style='width:15.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Dcd</span></p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>14,8 %</span></p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>32,9 %</span></p>   </td>   <td width="28%" valign=top style='width:28.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>48,6 %</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>* Nombre de patients pour lesquels cette information est disponible<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Du nombre total de patients survivant l'AVC aprs huit semaines, un tiers ncessite beaucoup d'aide (tableau 5).<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 5</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Niveau d'autonomie des patients 1 et 8 semaines aprs l'ACV (1).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=491 style='width:368.25pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1 semaine (N=92*)</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>8 semaines (N=92*)</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Ne ncessite aucune aide</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>12,0%</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>30,4%</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Ncessite un peu d'aide</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>40,2%</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>39,1%</span></p>   </td>  </tr>  <tr>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Ncessite beaucoup d'aide</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>47,8%</span></p>   </td>   <td width="31%" valign=top style='width:31.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>30,4%</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>* Nombre de patients pour lesquels cette information est disponible <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>COMPARAISONS INTERNATIONALES (6)<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Des comparaisons avec des tudes dans d'autres pays s'avrent difficilement ralisables, surtout  cause des dissemblances possibles entre les pays quant aux critres de l'enregistrement des ACV. Lors de l'enregistrement des pratiques vigies en Belgique, on a fait l'addition des premiers AVC (first-ever strokes) et des rcidives. Ces &quot;first-ever strokes&quot; consituant 75 % de tous les AVC, montraient une autre rpartition des classes d'ge que celle propre aux rcidives (4). <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Le tableau 6 numre les incidences de cinq tudes qui satisfaisaient aux conditions de &quot;critres idaux&quot; (description complte des cas, tude englobant des groupes larges et reprsentatifs de la population, des reprsentations standardises des incidences, voir (6)). Leurs rsultats furent comparables.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Les incidences leves en Sude sont assez surprenantes, bien que la valeur de la mortalit spcifique pour les AVC s'avre dans ce pays la plus basse parmi tous les pays mentionns dans le tableau.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Les autres tudes dmontrent des taux d'incidences qui se rapprochent.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Deux tudes ont t retenues comme tudes &quot; une tendance idale&quot;, celle de Soderhamn (Sude) et celle de Rochester (EU).<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Un grand dcalage est apparu dans l'tude sudoise quant aux incidences annuelles rcoltes pendant deux priodes, 1976 et 1984. La trs nette augmentation de l'incidence entre les deux annes concernant la tranche d'ge &gt;= 85 ans est trs probablement attribuable  un accroissement du nombre de personnes ges durant l'intervalle.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>L'tude de Rochester, qui a enregistr les incidences  partir de 1945 durant 35 ans, montra une baisse de l'incidence de 54 % concernant l'apparition du premier AVC entre la premire et la dernire priode de cinq ans (7). L'apparition des antihypertensifs efficaces pendant ce temps a certainement jou un rle dans ce phnomne.<o:p></o:p></span></p>  <p><i><u><span style='font-size:10.0pt;font-family:"Lucida Console"'>Tableau 6</span></u></i><span style='font-size:10.0pt;font-family:Arial'>: Incidence moyenne annuelle des AVC selon l'ge dans des tudes &quot;idales&quot;, deux sexes (6).<o:p></o:p></span></p>  <table border=1 cellspacing=1 cellpadding=0 width=548 style='width:411.0pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td colspan=7 valign=top style='border:inset black .75pt;padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence annuelle du   premier ACV par classe d'ge (/10.000)</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Etude</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>Anne moyenne approximative de l'tude</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>55-64</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>65-74</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>75-84</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>&gt;=75</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>&gt;=80</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Tilburg, NL</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1979</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>2,0</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>6,9</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>16,1</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Oxfordshire, GB</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1983</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>3,1</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>7,2</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>14,3</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>24,2</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Soderhamn, S</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1976</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>2,2</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>8,9</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>19,6</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>30,5</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p>&nbsp;</p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1984</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>3,5</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>8,8</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>24,2</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>37,7</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Espoo-Kauniainen, FIN</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1979</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>2,4</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>6,5</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>13,5</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>  </tr>  <tr>   <td width="29%" valign=top style='width:29.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Rochester, USA</span></p>   </td>   <td width="23%" valign=top style='width:23.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1977</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>1,7</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>5,1</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>9,6</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>ne</span></p>   </td>   <td width="10%" valign=top style='width:10.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=center style='text-align:center'><span style='font-size:10.0pt;   font-family:Arial'>10,3</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>ne = non enregistr<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>BIBLIOGRAPHIE<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>1. Van Casteren V and Van der Veken J. La morbidit en Belgique en 1988-1989.Institut d'Hygine et d'Epidmiologie. Bruxelles. Socit Scientifique de Mdecine Gnrale, 1990<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>4. Burt M.J., Halliday J.W., Powell L.W. - Iron and coronary heart disease. Br Med J 1993; 307: 575-576.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>6. Malmgren R., Warlow C., Bamford J., Sandercock P. - Geographical and secular trends in stroke incidence. Lancet 1987; 1196-1199. <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>7. Oppenheimer S., Hachinski V. - Complications of acute stroke. Lancet 1992; 339: 721-724.<o:p></o:p></span></p>  <p><span style='font-family:Arial;color:green'>&nbsp;<o:p></o:p></span></p>  <p><b><span style='font-family:Arial;color:green'>RESUME - PREVENTION - CONCLUSION</span></b><span style='font-family:Arial;color:green'> <o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>RESUME (1)<o:p></o:p></span></u></b></p>  <table border=1 cellspacing=1 cellpadding=0 width=491 style='width:368.25pt;  mso-cellspacing:.7pt;border:outset black .75pt;mso-padding-alt:5.25pt 5.25pt 5.25pt 5.25pt'>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence des AIT* en   Belgique</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>10,2/10.000 personnes</span></p>   </td>  </tr>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre attendu de cas AIT   par an</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>10.014</span></p>   </td>  </tr>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Incidence ACV** en   Belgique</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>23,0/10.000 personnes</span></p>   </td>  </tr>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre attendu de cas AVC   par an</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>22.731</span></p>   </td>  </tr>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre de dcs 8   semaines aprs l'AVC</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>48,6 %</span></p>   </td>  </tr>  <tr>   <td width="62%" valign=top style='width:62.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p><span style='font-size:10.0pt;font-family:Arial'>Nombre de personnes   ncessitant d'aide 8 semaines aprs l'AVC</span></p>   </td>   <td width="38%" valign=top style='width:38.0%;border:inset black .75pt;   padding:5.25pt 5.25pt 5.25pt 5.25pt'>   <p align=right style='text-align:right'><span style='font-size:10.0pt;   font-family:Arial'>30,4 %</span></p>   </td>  </tr> </table>  <p><span style='font-size:10.0pt;font-family:Arial'>* Accident ischmique transitoire<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>** Accident vasculaire crbral <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>CONCLUSIONS<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Bien que le traitement et la prvention secondaire des AVC a des perspectives promettantes en vue (7), ces affections occupent toujours une place importante dans le cadre de la balance des morbidits et de la mortalit spcifique. Presque 40 % des patients ncessitent encore une aide huit semaines aprs l'accident. Selon des calculs de l'Institut Belge de l'Economie de la Sant (IBES), la mortalit relle dans notre pays par les affections crbro-vasculaires fut de 10.149 dcs en 1988 et pendant la mme anne, on a pu viter 10.146 dcs (8).<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>En prenant en considration les facteurs de risque, il est possible de diminuer le nombre des AVC (5):<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>-.la prvention primaire consiste en un dpistage systmatique des personnes  une tension artrielle leve au sein des groupes  risque (tous les adultes, les personnes avec des antcdents familiaux, les diabtiques et autres).<o:p></o:p></span></p>  <p style='margin-left:72.0pt'><span style='font-size:10.0pt;font-family:Arial'>- la prvention secondaire s'efforcera de diminuer la pression systolique par voie mdicamentale et par un rgime alimentaire. Concernant la voie mdicamentale, l'on recommande l'aspirine (9). Une dose de 300 mg peut inhibiter immdiatement l'agglutination des thrombocytes et comme thrapie de soutien, une dose journalire de 75  150 mg est conseille. Si l'aspirine n'est pas tolre, on peut prescrire la ticlopidine.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>Parmi les changements du rgime on note (5): diminution de l'ingestion journalire de sel  une quantit de 100 mmol et une augmentation de l'ingestion de potasse de 30 mmol, une rduction de l'indice de Qutelet modifi (&quot;body mass index&quot; = poids corporel/ taille) de 5 et une restriction journalire d'alcool jusque moins de trois verres. Toutes ces mesures seraient dj responsables d'une diminution moyenne de la pression systolique de 11 mm. Selon certains avis (10), les dcs par les AVC pourraient reculer de 50 % par une mise en application des connaissances actuelles.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>&nbsp;<o:p></o:p></span></p>  <p><b><u><span style='font-family:Arial'>BIBLIOGRAPHIE<o:p></o:p></span></u></b></p>  <p><span style='font-size:10.0pt;font-family:Arial'>1. Van Casteren V and Van der Veken J. La morbidit en Belgique en 1988-1989.Institut d'Hygine et d'Epidmiologie. Bruxelles. Socit Scientifique de Mdecine Gnrale, 1990<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>4. Burt M.J., Halliday J.W., Powell L.W. - Iron and coronary heart disease. Br Med J 1993; 307: 575-576.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>7. Oppenheimer S., Hachinski V. - Complications of acute stroke. Lancet 1992; 339: 721-724.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>8. Verrijken G. - Quand les mdicaments sauvent la vie. Le Journal du Mdecin 1993; 3<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>9. Warlow C. - Secondary prevention of stroke. Lancet 1992; 339: 724-727.<o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial'>10. Law M.R., Frost C.D., Wald N.J. - By how much does dietary salt reduction lower blood pressure? I: analysis of observational data among populations. British. Medical. Journal 1991; 302: 811-815.<o:p></o:p></span></p>  <p><span style='font-family:Arial;color:green'>&nbsp;<o:p></o:p></span></p>  <p align=center style='text-align:center'><img width=513 height=8 id="_x0000_i1027" src="..\..\GIFS\MB1.GIF"></p>  <p align=center style='text-align:center'><a href="..\shortcut.htm"><span style='font-family:Arial'>Menu principal</span></a><span style='font-family: Arial'> <o:p></o:p></span></p>  <p><span style='font-size:10.0pt;font-family:Arial;color:red'>Vos remarques:&nbsp;<img border=0 width=44 height=51 id="_x0000_i1028" src="..\..\GIFS\MBmail.gif"> </span><a href="mailto:Morbidat@ihe.be"><span style='font-size:10.0pt;font-family:Arial'>Morbidat@ihe.be</span></a><span style='font-size:10.0pt;font-family:Arial;color:red'><o:p></o:p></span></p>  </div>  </body>  </html> 
