You can obviously see that the WSO has zero interest in stroke survivors. And they take no responsibility in solving stroke, pushing prevention only.
A social dimension for brain health: the mounting preessure
Published:October, 2021DOI:https://doi.org/10.1016/S1474-4422(21)00295-7 o
The prevention of stroke and dementia is the title and focus of the first webinar in an ongoing series on Global Policy organised by the World Stroke Organization (WSO). The series follows up on the WSO Declaration
from 2020 that recommended “a joint prevention strategy” for these
neurological diseases “given the commonality of risk factors and the
reciprocal relationship of stroke and dementia”. WSO wants
population-wide primary prevention strategies to become a global
priority, which is a sound evidence-based approach to stop the huge
burden of these diseases. However, implementation of population-wide
strategies cannot be done in neurology clinics and, instead, requires
emphasis on improving public health.
The burden of stroke
keeps increasing, particularly in low-income countries. The diverging
trends between high-income countries (in which some decreases in
stroke-related mortality and disability have been accomplished) and
other regions are growing. Underlying these disparities are both the
limited availability and quality of stroke services in low-income and
middle-income countries and also the mounting exposure of their citizens
to some modifiable risk factors. Among such factors, globally, high
systolic blood pressure is associated with the highest number of
disability-adjusted life-years (DALYs) after a stroke. More than 50% of
stroke-related DALYs in low-income countries can be attributed to
hypertension.
This situation is not surprising. The high risk of cardiovascular events and stroke attributable to hypertension
has been well known by epidemiologists for decades. Nevertheless, the
number of people with hypertension has doubled over the past 30 years.
In 2019, more than half of them (about 720 million people) were not
receiving any treatment and were possibly unaware of their condition.
Although in several high-income countries the prevalence of hypertension
has decreased substantially, in poorer countries the rates keep
increasing.
Hypertension,
particularly in midlife, is also associated with an accelerated rate of
cognitive decline at older age and accounts for a substantial proportion of dementia cases worldwide.
Several studies have demonstrated that blood pressure lowering can
reduce the progression of vascular lesions in the brain (ie, the volume
of white matter hyperintensities, which is a risk factor for cognitive
impairment). Furthermore, the US and Puerto Rico Systolic Blood Pressure
Intervention Trial (SPRINT) also showed that intensive blood pressure
control (<120 mm Hg) can reduce the incidence of not only stroke and
cardiovascular events, but also mild cognitive impairment. Findings from these and several other trials and longitudinal studies
support blood-pressure control as an intervention for the primary
prevention of dementia. Evidence is not yet conclusive, however, with
respect to optimal blood pressure thresholds and timing for blood
pressure control, or regarding the population that could benefit the
most. Further research is needed to determine these parameters. In the
meantime, while optimal management and use of antihypertensive drugs are
being outlined, the strategies for primary prevention of dementia must
address inequalities in exposure to hypertension and other risk factors.
The
reduction of a risk factor responsible for such an enormous burden of
stroke and dementia is indeed a public-health challenge that requires
societal action. For instance, policies should make healthy diets with
reduced salt intake, and more fruits and vegetables, affordable and
widely available. In low-income countries, primary care and universal
health coverage are key to improve detection and monitoring of
hypertension. Better socioeconomic status leads to a longer, healthier
life and more resilient brain. Incidence rates of stroke and dementia
are now lower in many high-income countries than they were a few decades
ago because of better living conditions and improved access to
healthcare and education throughout the lifespan.
In their Declaration
for a common prevention strategy for stroke and dementia, WSO rightly
calls for “abandoning categorisation of people into low, moderate, and
high risk” and promoting instead a “holistic prevention approach” for
the whole population. Such an approach must have a life-course
perspective of brain health, starting in early life, with favourable
environments that facilitate healthy diets, physical activity, and
better education. Hypertension control and the consequent prevention of
neurological disease will be achieved only by considering the many
non-medical factors that influence neurological outcomes.
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