This paper presents urgent and essential information regarding the global burden of stroke. We concluded that current stroke prevention strategies are not sufficient, and that governments of all countries should develop and implement, evidence-based plans that promote healthy behaviors and effective interventions to reduce the risk of stroke, or treat it when it occurs. Gregory Roth, M.D., Assistant Professor at IHME and the Division of Cardiology at the University of Washington School of Medicine
Originally published by Auckland University on July 22, 2016
International stroke prevention measures are not effective and need to change, say the authors of a study published in Nature Reviews Neurology 22 July 2016 (http://www.nature.com/nrneurol/journal/vaop/ncurrent/abs/nrneurol.2016.107.html).
The paper shows that the international burden of stroke and other major non-communicable diseases (NCDs) such as stroke, diabetes and dementia is increasing rapidly, and the high-risk prevention approach being taken is inadequate.
“The evidence is clear. Simply screening for high levels of cardiovascular risk, even with some counselling, is not effective in reducing incidence or mortality from cardiovascular disease,” says Valery Feigin, lead author and Professor of Neurology and Epidemiology at Auckland University of Technology (AUT).
He points to findings from the study, which analysed the most recent literature on stroke epidemiology. “There is evidence from 240,000 participants in randomised clinical trials that screening for cardiovascular risk had no effect on health outcomes ten years on,” he says.
Although global stroke incidence and mortality declined from 1990 to 2013, the absolute numbers of people affected by stroke is rising rapidly throughout the world. This increasing burden of stroke, including the lifelong disability many stroke survivors suffer, indicates deficiencies in current stroke prevention strategies. These deficiencies are further highlighted by significant gender and ethnic disparities, and a trend towards more strokes in younger people.
According to Professor Feigin, current screening measures give false reassurance to people classified as low to moderate risk – the group in which approximately 80 per cent of all strokes occur. Some of these individuals have isolated hypertension and many have other risk factors. With the exception of smoking however, behavioural risk factors such as poor diet, sedentary lifestyle and excessive alcohol intake are not usually included in the cardiovascular risk algorithms that are currently used. This is despite the fact that nearly three quarters of the global burden of stroke is linked to lifestyle choices.
Professor Feigin and his co-authors recommend governments introduce taxation to control nutritional, alcohol and tobacco-related risks – a proven risk mitigation method that would generate funding for population wide prevention initiatives and abolition of the emphasis on high risk individuals.
“Given the dramatically increasing global burden of stroke, this call to action in stroke prevention, from Feigin, Norrving and colleagues is strongly supported by the World Stroke Organization. They have highlighted the importance of a comprehensive population-based approach to primary stroke prevention, integrating with the strategies for other Non-Communicable diseases with similar risk factors. This should include early life interventions. They have highlighted behavioural, lifestyle and environmental factors and the potential for specific revenue raising to support these initiatives. They have also indicated the potential of using electronic information technology such as smartphone apps. Potentially these strategies could save millions of lives and have a huge impact on the burden of disability after stroke,” says Professor Stephen Davis, President of the World Stroke Organization.
“Stroke is largely a lifestyle disease. With better strategies in place, we could prevent three quarters of all strokes and heart attacks, and extend our stroke, heart attack, dementia and diabetes-free lives by 20-30 years,” says Professor Feigin.
For media enquiries, please contact:
Professor Valery Feigin, Director of the AUT National Institute for Stroke and Applied Neurosciences, Auckland University of Technology
E: [email protected] ǀ T: 0062 9 921 9999, extension 9166
Susannah Dalton, Communications Manager, Auckland University of Technology
E: [email protected] ǀ T: 0064 21 0293 1092