Tracking the global burden of stoke and dementia: World Stroke Day 2020

Notice ABSOLUTELY NOTHING ON STROKE RECOVERY, just lazy prevention crapola.  Sorry about being so late with this, was going thru old draft posts and this one needed to be said.

Tracking the global burden of stoke and dementia: World Stroke Day 2020

Hugh S Markus, Michael Brainin, Marc Fisher

First Published October 29, 2020 Editorial 

https://doi.org/10.1177/1747493020959186

Article information

This World Stroke Day edition of the International Journal of Stroke (IJS) celebrates World Stroke Day, which is commemorated each year on 29th October. This annual focal point of the World Stroke Organization’s (WSO) public awareness activities was started in 2004 at the World Stroke Congress in Vancouver, Canada. On this day annually organizations around the world come together to increase visibility for stroke through community and policy events and online communication aimed at improving public awareness of stroke prevention and symptoms.

World Stroke Day focuses on a particular theme each year. In 2020 the WSO’s commitment to stroke prevention continues with a campaign that builds on the momentum of 2019 #DontBeTheOne which highlighted the one in four life-time risk of stroke and the importance of addressing individual risk factors for stroke. This year, the campaign focuses on the importance of physical activity for stroke prevention. This is combined with a call to action to “Join The Movement” which points people to the Stroke Riskometer (https://www.strokeriskometer.com/), the WSO endorsed mobile app that supports individual risk assessment and access to information about the top 10 stroke risk factors and how these can be reduced.

Despite many advances in stroke prevention and care, the most recent WSO analysis of Global Burden of Disease data found that the adult lifetime risk of stroke remains at 1 in 4 and 13.7 million people suffer stroke annually, accounting for 116 million days of healthy life lost each year.^1,2 Tackling this epidemic requires national stroke prevalence, outcome and treatment data, alongside evidence-based frameworks, to guide the effective deployment of resources, workforce, and interventions. Prevention is by far the most effective strategy to reduce the global burden of stroke.(So you given up on recovery? Good to know we have NO stroke leadership at all. You can tell your children and grandchildren they are completely screwed when they have a stroke.) While secondary prevention, or identification of high-risk groups, is effective for the individuals concerned, to have a major impact on a global basis a population-based approach is required. Studies such as INTERSTROKE suggest that 90% of stroke risk is accounted for by a limited number of potentially modifiable risk factors, and increasing evidence suggests that tackling these modifiable risk factors can result in a significant reduction in stroke incidence.³

The WSO recommends that primary stroke prevention interventions meet the following criteria: (a) sufficient evidence of efficacy, (b) potential population-wide coverage, (c) applicability for both stroke and dementia prevention, and (d) low cost and affordability even in low- and middle-income countries (LMIC).⁴ Of the available strategies analyzed by the WSO, only four were found to meet these criteria; population-based strategies to reduce exposure to risk factors (for example, pollution), community health worker interventions to reduce modifiable risk factors, a polypill strategy (consisting of blood pressure drugs and lipid lowering medication for adults at risk of cardiovascular disease), and a motivational e-health app. All approaches are applicable even in LMIC; for example, a study in Iran demonstrated that a polypill approach (contacting hydrochlorothiazide 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg) was effective for both primary and secondary prevention of cardiovascular disease including stroke.⁵ Using a combination of these approaches, the WSO has adopted an ambitious plan to “cut stroke in half.”^4,6

Responding to prevention and patient needs requires detailed knowledge on national stroke incidence and outcome, as well as data on the provision of stroke care. This month, as part of our contribution to World Stroke Day, we publish Global Stroke Statistics 2019.⁷ This provides informative data on the current incidence, mortality, and case fatality of stroke and its variation across the globe. Once again it shows striking regional differences in incidence and mortality, although also highlights that more up to date data is required from many countries.

There are some striking success stories. For example, Kazakhstan has moved from worst place in terms of mortality rating, to 38th among those countries where data is available. This is a commendable improvement in stroke mortality over the 12-year period from 2003 to 2015. But such impressive declines in mortality are not consistent worldwide. The stroke unit care statistics also make interesting, and salutary reading. Although data was not available from many countries, stroke unit coverage varied widely with the proportion being treated within a stroke unit ranging between 1% and 90%, despite strong evidence that stroke units improve outcome. Papers such as this are vital and provide baseline data for countries around the world helping them better plan and track strategies to reduce the global burden of stroke.

The WSO strategies for preventing stroke are far reaching and even if only partially successful will have enormous impact. But the true benefit is likely to be even greater, because similar health prevention behavior will have impacts on diseases other than stroke, in particular dementia. Stroke itself is a major risk factor for dementia, and increasing evidence implicates cardiovascular risk factors,⁸ and radiological features of cerebral small vessel disease,⁹ as risk factors not only for vascular dementia but also for Alzheimer’s dementia. Exciting recent data from the SPRINT-MIND trial suggests primary prevention of risk factors such as hypertension may reduce future dementia risk,¹⁰ while the FINGERS collaboration suggests that multimodality interventions including exercise have benefit.¹¹ Perhaps the 29th of October should be renamed World Stroke and Dementia Day? This would fit with the WSO Declaration of 2020 in which the primary prevention of not only stroke, but also dementia, was adopted as a priority.⁶

Join us on October 29th to raise awareness of stroke and the action we can all take at global, national, and individual level, to prevent stroke and dementia.