Prevention of stroke: a strategic global imperative

Abstract

The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.

Conflict of interest statement

Conflict of interest

Valery L. Feigin declares that Stroke Riskometer™ app is copyrighted by the Auckland University of Technology and funds resulting from the sale of the professional version of the Stroke Riskometer App will be used for further research and education for stroke prevention. All other authors declare that they have no conflict of interest.

Figures

Figure 1.

Age-standardised prevalence and mortality of ischaemic stroke per 100,000 person-years in various regions in 2013

Figure 2.

Age-standardised prevalence and mortality of haemorrhagic stroke per 100,000 person-years in various regions in 2013

Figure 3:

Stroke-related deaths and DALYs by country development status.

Figure 4.

Proportional (%) contribution of ischaemic and haemorrhagic strokes burden (with 95% uncertainty intervals [UI]) to all health conditions by country development status in 2013 (modified from Feigin et al.)

Figure 5.

Incidence per 100,000 of ischemic and haemorrhagic stroke in females and males by 5-year age bands in 2013 (modified from S Barker-Collo et al.)

Figure 6.

Optimal shift in the distribution of CVD risk by combination of population-wide and high-risk prevention strategies (modified from WHO “Cardiovascular disease prevention. Translating evidence into action”.)