Q&A with Professor Valery Feigin, Director of the National Institute for Stroke and Applied Neurosciences, and Professor of Epidemiology & Neurology at AUT University, New Zealand
What are the most important findings from this study?
There are four main findings:
(1) There is a nearly five-fold geographical difference in the lifetime stroke risk, with the highest risk in East Asia (about 39%) and Central and Eastern Europe (about 32%);
(2) Globally, the lifetime stroke risk is one in four;
(3) From 1990 to 2016, the lifetime stroke risk increased by 9%; and
(4) The exact lifetime stroke risk estimates and their trends are now available for 195 countries, thus allowing more targeted educational and primary stroke prevention campaigns.
Were there any conclusions that surprised you?
Yes, two things. First, the lifetime risk of stroke remains relatively stable between the ages of 25 and 75, implying that the intensity of primary stroke prevention should not be reduced in older people. The importance of these findings for education and primary stroke prevention is really huge. Moreover, there is no sex difference in the lifetime risk of stroke.
How can people prevent strokes?
Most importantly, every individual needs to be aware of his or her risk of having a stroke and his or her own risk factors. Secondly, it is essential to know how to control those risk factors and to monitor individual progress. There is robust evidence that just giving all people advice and brochures to follow a healthy lifestyle is not working. People need to be personally motivated.
Currently, there is a mobile tool called Stroke Riskometer app that allows people to address all these issues and preliminary evidence suggests its efficacy. The app has been translated into 14 languages and endorsed by the World Stroke Organization, World Heart Federation, and World Federation of Neurology. It was estimated that with the wide use of the app, it might be possible to avoid over 400,000 strokes annually.
What should health officials focus on from this study?
The risk and burden of stroke is large and continuously increasing across the globe. The question is why.
Some may ask, “Is it only because of the aging of the population and population growth?” If so, then the same changes in trends would be observed for other age-related non-communicable diseases that share similar risk factors. But, if we look at the proportional contribution of stroke deaths and disability to deaths and disability from all diseases, we can see that deaths and disability from stroke have significantly and disproportionally increased compared to other diseases.
In addition, stroke has moved from the third to the second largest cause of disability worldwide. Stroke has also become younger, with almost 60% of all strokes happening in people under the age of 70, and there is a clear trend toward increasing stroke incidence and prevalence rates in the world after 2010.
Finally, over the last 30 years virtually all countries have all observed a global epidemic of overweight and type 2 diabetes, all of which are important risk factors for stroke. This suggests that current stroke prevention strategies are not sufficiently effective. As a result, there is an urgent need to improve stroke prevention across all countries.