Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

 And since no hospital is reporting on their 30-day deaths. You can't improve a damn thing if you don't measure it. THAT'S HOW FUCKING BAD THE STROKE MEDICAL WORLD IS! TOTAL INCOMPETENCE!

“What's measured, improves.” So said management legend and author Peter F. Drucker 

 

Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

Published: October 9, 2023

Executive Summary

The burden of mortality and disability caused by stroke is rapidly increasing worldwide, particularly in countries where the resources to tackle this burden are scarce. However, the implementation of evidence-based interventions could reverse these epidemiological trajectories. A large proportion of strokes can be prevented and, for most patients who present to a stroke unit during the first few hours after the onset of symptoms, treatment can improve survival and functional outcomes(But not 100% recovery! So I consider that complete failure!). Furthermore, rehabilitation interventions can reduce disability(But not 100% recovery! So I consider that complete failure!) in stroke survivors, improving quality of life for patients and carers.  

In this Lancet Neurology Commission, the World Stroke Organisation (WSO) draws up its roadmap to tackle the burden of stroke by 2030 and beyond, in line with the UN Sustainable Development Goal on health and wellbeing.  If implemented by policy makers, in collaboration with stakeholders(I expect dozens of survivors invited to be main contributors!) in every country, the WSO recommendations could lead to substantial improvements in prevention of stroke, acute treatment, and rehabilitation worldwide. The Commission also provides guidance on the epidemiological surveillance necessary to monitor progress.

Commission

Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

Valery L Feigin, Mayowa O Owolabi on behalf of the World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group

The Lancet Neurology

Published: October 9, 2023

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Neurologists need to warn patients of the illusions of pseudomedicine for dementia, say Lancet Neurology editors

This is another example of laziness, warning against stuff but offering NOTHING useful in response, except guidelines. 

Neurologists need to warn patients of the illusions of pseudomedicine for dementia, say Lancet Neurology editors

Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study

By focusing on blaming the patient these researchers are giving the ok to not even try to solve ANY of the fucking problems in stroke. 'You caused your own stroke, live with the consequences', not a direct quote but implied.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960834-3/abstract

Dr Martin J O'Donnell, PhDPress enter key for correspondence informationPress enter key to Email the author

,

Prof Denis Xavier, MD

,

Prof Lisheng Liu, MD

,

Prof Hongye Zhang, MD

,

Siu Lim Chin

,

Purnima Rao-Melacini, MSc

,

Sumathy Rangarajan, MSc

,

Shofiqul Islam, MSc

,

Prof Prem Pais, MD

,

Prof Matthew J McQueen, MBChB

,

Charles Mondo, MD

,

Prof Albertino Damasceno, MD

,

Prof Patricio Lopez-Jaramillo, MD

,

Prof Graeme J Hankey, FRACP

,

Prof Antonio L Dans, MD

,

Prof Khalid Yusoff, FRCP

,

Thomas Truelsen, DMSc

,

Prof Hans-Christoph Diener, MD

,

Prof Ralph L Sacco, MD

,

Prof Danuta Ryglewicz, MD

,

Prof Anna Czlonkowska, MD

,

Prof Christian Weimar, MD

,

Prof Xingyu Wang, PhD

,

Prof Salim Yusuf, DPhil

, on behalf of the INTERSTROKE investigators^‡

^‡Members listed at end of paper

Published: 18 June 2010

DOI: http://dx.doi.org/10.1016/S0140-6736(10)60834-3

This article can be found in the following collections: Cerebrovascular disease

• Summary

• Full Text
• Tables and Figures
• References

Summary

Background

The contribution of various risk factors to the burden of stroke worldwide is unknown, particularly in countries of low and middle income. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction.

Methods

We undertook a standardised case-control study in 22 countries worldwide between March 1, 2007, and April 23, 2010. Cases were patients with acute first stroke (within 5 days of symptoms onset and 72 h of hospital admission). Controls had no history of stroke, and were matched with cases for age and sex. All participants completed a structured questionnaire and a physical examination, and most provided blood and urine samples. We calculated odds ratios (ORs) and population-attributable risks (PARs) for the association of all stroke, ischaemic stroke, and intracerebral haemorrhagic stroke with selected risk factors.

Findings

In the first 3000 cases (n=2337, 78%, with ischaemic stroke; n=663, 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all stroke were: history of hypertension (OR 2·64, 99% CI 2·26–3·08; PAR 34·6%, 99% CI 30·4–39·1); current smoking (2·09, 1·75–2·51; 18·9%, 15·3–23·1); waist-to-hip ratio (1·65, 1·36–1·99 for highest vs lowest tertile; 26·5%, 18·8–36·0); diet risk score (1·35, 1·11–1·64 for highest vs lowest tertile; 18·8%, 11·2–29·7); regular physical activity (0·69, 0·53–0·90; 28·5%, 14·5–48·5); diabetes mellitus (1·36, 1·10–1·68; 5·0%, 2·6–9·5); alcohol intake (1·51, 1·18–1·92 for more than 30 drinks per month or binge drinking; 3·8%, 0·9–14·4); psychosocial stress (1·30, 1·06–1·60; 4·6%, 2·1–9·6) and depression (1·35, 1·10–1·66; 5·2%, 2·7–9·8); cardiac causes (2·38, 1·77–3·20; 6·7%, 4·8–9·1); and ratio of apolipoproteins B to A1 (1·89, 1·49–2·40 for highest vs lowest tertile; 24·9%, 15·7–37·1). Collectively, these risk factors accounted for 88·1% (99% CI 82·3–92·2) of the PAR for all stroke. When an alternate definition of hypertension was used (history of hypertension or blood pressure >160/90 mm Hg), the combined PAR was 90·3% (85·3–93·7) for all stroke. These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke.

Interpretation

Our findings suggest that ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke.

Funding

Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Pfizer Cardiovascular Award, Merck, AstraZeneca, and Boehringer Ingelheim.

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Reducing the global burden of stroke: INTERSTROKE

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Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis

It seems there was not a single trial on use of regular foods(creating nitric oxide) to lower blood pressure. Everything was drug/pharma based. This is precisely why we need a great stroke association that runs its' own clinical trials. Drug companies are biased and the government will soon cease to provide money for any research. Stroke associations that don't recognize these trends will die.

Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis

Dena Ettehad, MSc

,

Connor A Emdin, HBSc

,

Amit Kiran, PhD

,

Simon G Anderson, PhD

,

Thomas Callender, MB ChB

,

Jonathan Emberson, PhD

,

Prof John Chalmers, PhD

,

Prof Anthony Rodgers, PhD

,

Prof Kazem Rahimi, DM FRCP

Published Online: 23 December 2015

DOI: http://dx.doi.org/10.1016/S0140-6736(15)01225-8

Article Info

Publication History

Published Online: 23 December 2015

© 2015 Elsevier Ltd. All rights reserved.

• Summary
• Full Text
• Tables and Figures
• References
• Supplementary Material

Summary

Background

The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established. However, the extent to which these effects differ by baseline blood pressure, presence of comorbidities, or drug class is less clear. We therefore performed a systematic review and meta-analysis to clarify these differences.

Method

For this systematic review and meta-analysis, we searched MEDLINE for large-scale blood pressure lowering trials, published between Jan 1, 1966, and July 7, 2015, and we searched the medical literature to identify trials up to Nov 9, 2015. All randomised controlled trials of blood pressure lowering treatment were eligible for inclusion if they included a minimum of 1000 patient-years of follow-up in each study arm. No trials were excluded because of presence of baseline comorbidities, and trials of antihypertensive drugs for indications other than hypertension were eligible. We extracted summary-level data about study characteristics and the outcomes of major cardiovascular disease events, coronary heart disease, stroke, heart failure, renal failure, and all-cause mortality. We used inverse variance weighted fixed-effects meta-analyses to pool the estimates.

Results

We identified 123 studies with 613 815 participants for the tabular meta-analysis. Meta-regression analyses showed relative risk reductions proportional to the magnitude of the blood pressure reductions achieved. Every 10 mm Hg reduction in systolic blood pressure significantly reduced the risk of major cardiovascular disease events (relative risk [RR] 0·80, 95% CI 0·77–0·83), coronary heart disease (0·83, 0·78–0·88), stroke (0·73, 0·68–0·77), and heart failure (0·72, 0·67–0·78), which, in the populations studied, led to a significant 13% reduction in all-cause mortality (0·87, 0·84–0·91). However, the effect on renal failure was not significant (0·95, 0·84–1·07). Similar proportional risk reductions (per 10 mm Hg lower systolic blood pressure) were noted in trials with higher mean baseline systolic blood pressure and trials with lower mean baseline systolic blood pressure (all p_trend>0·05). There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history, except for diabetes and chronic kidney disease, for which smaller, but significant, risk reductions were detected. β blockers were inferior to other drugs for the prevention of major cardiovascular disease events, stroke, and renal failure. Calcium channel blockers were superior to other drugs for the prevention of stroke. For the prevention of heart failure, calcium channel blockers were inferior and diuretics were superior to other drug classes. Risk of bias was judged to be low for 113 trials and unclear for 10 trials. Heterogeneity for outcomes was low to moderate; the I² statistic for heterogeneity for major cardiovascular disease events was 41%, for coronary heart disease 25%, for stroke 26%, for heart failure 37%, for renal failure 28%, and for all-cause mortality 35%.

Interpretation

Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mm Hg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease.

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Research: increasing value, reducing waste

This whole series may come from the Lancet but is easily applied to any stroke research out there.
I have pointed out numerous times where researchers obviously haven't looked at or considered past research in their field.
http://www.thelancet.com/series/research
These are the reasons we need a great stroke association with a strategy and plan  on how to reduce stroke disability and death. It's not rocket science, normal people with a modicum of brains can understand the existing failures in the current situation.  We need that great stroke association to set research priorities.

How should medical science change?

How to increase value and reduce waste when research priorities are set

Increasing value and reducing waste in research design, conduct, and analysis

Increasing value and reducing waste in biomedical research regulation and management

Increasing value and reducing waste: addressing inaccessible research

Reducing waste from incomplete or unusable reports of biomedical research

 

 

 

Unmasking the benefits of B vitamins in stroke prevention

Not much to go on here, can't tell if this is dietary or supplements. Your doctor should be subscribing to The Lancet. You can check out other commentary here:
http://oc1dean.blogspot.com/2011/12/jama-commentary-contends-vitamin.html
The Lancet here:
 http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2812%2970094-7/fulltext
 Vitamin B12 and folate are key mediators of homocysteine metabolism. Low plasma vitamin B12 and folate concentrations are associated with hyperhomocysteinaemia, with consequent premature atherosclerosis and increased risk of cardiovascular and cerebrovascular disease.1,2 In a meta-analysis of observational studies, a 25% reduction in homocysteine concentrations (roughly 3 μmol/L [0·41 mg/L]) corresponded with an 11% lower risk of ischaemic heart disease and a 19% lower risk of stroke.3 The Heart Outcomes Prevention Evaluation 2 (HOPE 2) trial4 and re-analysis of data from the Vitamin Intervention for Stroke Prevention (VISP) study5 (both trials in which patients received high doses of B vitamins) have confirmed these findings for stroke.