Blaming the victim completely. This mindset allows our stroke medical 'professionals' to not bother trying to solve all the problems in stroke. Yet somehow even though almost all car crashes are preventable the medical profession still works on treating those victims and continues research to make those treatments better. A great stroke association president would not hunker behind victim blaming and would tackle BHAGs(Big Hairy Audacious Goals)
Globally, stroke is almost entirely caused by modifiable risk
factors, with air pollution emerging as a significant contributor, a
systematic analysis showed.
Modifiable risk factors were determined responsible for 90.5% (95%
uncertainty interval 88.5-92.2) of the global stroke burden, as measured
using disability-adjusted life years,
Valery Feigin MD, PhD, of New Zealand's Aukland University of Technology, and colleagues reported online in
Lancet Neurology.
Potentially
modifiable behaviors -- smoking, poor diet, and physical inactivity
-- contributed to 74.2% of strokes (95% UI 70.7-76.7). Metabolic
factors -- high systolic blood pressure, high body mass index (BMI),
high fasting plasma glucose, high total cholesterol, and low glomerular
filtration rate -- were attributable for 72.4% (95% UI 70.2-73.5).
The researchers also called attention to the "unexpectedly high"
29.2% (95% UI 28.2-29.6) of the burden of stroke attributed to air
pollution.
This factor had a strong association with stroke burden in Central,
Eastern, and Western sub-Saharan Africa, and South Asia, but a lower
association with stroke burden in North America, most areas of Europe,
Australasia, and Asia Pacific. This exemplified the variations in low-
and middle- income countries and high-income countries.
"Air pollution has emerged as a significant contributor to global
stroke burden, especially in low-income and middle-income countries, and
therefore reducing exposure to air pollution should be one of the main
priorities to reduce stroke burden in these countries," they wrote.
In an accompanying editorial,
Vladimir Hachinski MD, of the University of Western Ontario in London, and
Mahmoud Reza Azarpazhooh, MD,
of Iran's Mashhad University of Medical Sciences, agreed, calling the
percentage of strokes attributable to air pollution "alarming."
Their
Global Burden of Disease Study 2013 included data from 188 countries
from 1990 through 2013. Theoretical Minimum Risk Exposure Levels were
used to assess levels of relevant exposures to a population for the 17
risk factors identified. Finally, the population-attributable fraction
was calculated in order to determine the theoretical effect of
mitigating each risk factor.
In addition to individual risk factors, clusters of risk factors were
also assessed. These clusters of factors included behavioural, dietary,
environmental and occupational, and metabolic categories of risk.
Notably, 71.7% of the disability-adjusted life years that were lost to stroke were in patients under 70 years of age.
The five risk factors associated with the strongest impact on
disability-adjusted life years in developed countries were high systolic
blood pressure, high BMI, diet low in fruits, diet low in vegetables,
and smoking. The five risk factors with the strongest impact on
disability-adjusted life years in developing countries were high
systolic blood pressure, diet low in fruits, high BMI, diet high in
sodium, and smoking.
Whereas most risk factors showed a downward trend in their
contribution to stroke in high-income countries, a diet high in
sugar-sweetened beverages was the exception. Over the course of the
study, there was an almost 84% increase in stroke-related
disability-adjusted life years from sugary drinks in high-income
countries, compared with a 64% increase in its contribution globally.
Overall,
the burden of risk was higher in developing countries than it was in
developed countries, and almost all of the risk factors had a stronger
effect on disability-adjusted life years in the low- and middle- income
countries.
One limitation of the study was that atrial fibrillation, substance
abuse, and some other risk factors were not assessed due to lack of
data. One perplexing paradox indicated that in developing countries
there was a decrease in second-hand smoke, yet an increase in tobacco
smoking.
The editorial also noted that the cross-sectional, as opposed to
longitudinal, study design likely led to underestimation of the global
prevalence of stroke and its associated risk factors. However, it called
the "monumental task" of pulling together the attributable risk data a
success that "provides a firm basis for policy makers to implement
preventative measures."
The work was funded by government and foundation grants.
The
Stroke Riskometer app is copyrighted by the Auckland University of
Technology, and funds resulting from the sale of the professional
version of the app go into further research and education for stroke
prevention. Support was also provided by IBM Watson Health.
My reply to this:
Who is actually solving all the problems in stroke rather than blaming the victim?
88% failure rate of tPA for full recovery.
Only 10% of patients almost fully recover.
Nothing to cure spasticity.
Nothing to cure fatigue.
Nothing on preventing the likely chance of getting dementia.
No publicly available stroke rehab protocols with efficacy percentages.
No fast and accurate way to diagnose stroke, young persons are badly diagnosed.
