'Plateau' in progress on heart disease, stroke deaths

What the hell is your strategy to solve and reverse that problem in stroke? Hopefully it is to look at all the 30 day deaths and solve them. NOT by lazily putting out more prevention press releases. Damn it all, do the hard work to solve stroke. NOT just waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?

1.  Describe the problem exactly. 
2.  Write an RFP to researchers to solve that problem.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine  

'Plateau' in progress on heart disease, stroke deaths

The rate of deaths from heart disease barely decreased last year while deaths from stroke increased slightly, and life expectancy continued to slip in the U.S., according to federal statistics released Thursday.
The annual report on mortality from the Centers for Disease Control and Prevention found that heart disease killed 647,457 people in 2017, more than any other cause. The rate was 165 deaths per 100,000 people, a slight drop from 165.5 the year before.
Deaths from stroke on the other hand, the fifth-leading cause, increased 0.8 percent between 2016 and 2017. There were 146,383 stroke deaths in 2017, or a rate of 37.6 per 100,000 people.
Last year, the CDC issued a report warning that a decades-long decrease in stroke death rates had "slowed, stalled, or in some cases, reversed in recent years."
"This plateau in our progress to reduce heart disease and stroke deaths is disappointing, and we know there is much work to still be done," said Dr. Ivor J. Benjamin, president of the American Heart Association. "As we continue to see more scientific evidence supporting links between cardiovascular disease risk factors and so many other conditions, we are expanding our work in new directions that could have a profound impact on multiple fronts of our lifesaving mission."
The AHA is investing millions into areas related to brain health, such as Alzheimer's disease, and diabetes, a major risk factor for heart disease, said Benjamin, director of the Cardiovascular Center at the Medical College of Wisconsin.(Not one thing mentioned here has any specific measurable responsibility to solve all the problems in stroke. You fucking lazy bastards.)
Research shows people living with diabetes are at least two times more likely to develop and die from cardiovascular disease. Numerous studies also have linked brain and heart health.
"The more we learn about the fundamental causes of all deaths, we see so many connections that come back to the same risk factors that lead to heart disease and stroke," Benjamin said.
The CDC report showed Alzheimer's disease is the No. 6 cause of death, just behind stroke, and diabetes ranks seventh. The data tracked a 2.4 percent rise in diabetes-related deaths, from 80,058 in 2016 to 83,564 in 2017. Alzheimer's disease deaths rose 2.3 percent, from 116,103 to 121,404.
Here are other highlights from the CDC's National Center for Health Statistics report:

• The 10 leading causes of death, in order, are heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, flu and pneumonia, kidney disease, and suicide.

• Life expectancy decreased by slightly more than a month, to 78.6 years in 2017, largely because of increases in mortality from unintentional injuries, suicide, diabetes, and flu and pneumonia. The life expectancy decline follows a trend in recent years, with rates continuing to drop slightly since the 2015 rate of 78.8 years. "Life expectancy gives us a snapshot of the nation's overall health," CDC director Dr. Robert R. Redfield said in a statement, "and these sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable."

• Overall, men fared worse than women when it came to life expectancy. For men, life expectancy dropped from 76.2 to 76.1 years in 2017, while life expectancy for women stayed the same at 81.1 years.

• Drug overdose deaths rose by 9.6 percent, with the majority listed as unintentional. The report said 70,237 Americans died from drug overdoses in 2017 – or 21.7 deaths per 100,000 people. Synthetic opioids, including fentanyl, were the biggest factor, the report said.

• Flu and pneumonia claimed 5.9 percent more people, rising from 51,537 deaths in 2016 to 55,672 in 2017.

• Suicide deaths increased by 3.7 percent, from 44,965 in 2016 to 47,173 in 2017. Suicide rates in the U.S. have increased since 1999 for both men and women, and rates in the most rural U.S. counties are nearly twice as high as rates in the country's most urban counties.

If you have questions or comments about this story, please email editor@heart.org.

• Commentary from Christina M. Shay, director of Impact and Health Metrics at the American Heart Association: "US Life Expectancy Drops for Third Year in a Row – What We Know and Don’t Know From the 2017 CDC Mortality Report"

Stroke patients can benefit from clot-busting drug, shows brain scan study

You'll have to not so politely ask your stroke hospital to resolve the difference between these two articles. You brain is at risk if they don't do this correctly. Or maybe you'd rather die and have your heirs sue for malpractice. Up to you how you want to respond.

REVEALED: Most commonly prescribed stroke drug linked to fatal brain bleeds and death - Alteplase UK NHS

 Stroke patients can benefit from clot-busting drug, shows brain scan study

Study finds a 20-year decline in stroke risk and death rates

And none of this reduction is because the medical system knows how to treat the neuronal cascade of death. So doctors have no cause for celebration.
http://www.medicalnewstoday.com/articles/279695.php
The research was led by a team from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, and is published in JAMA.
Overall, the findings revealed a 24% drop in first-time strokes in both of the last 2 decades and a 20% drop per decade in deaths following a stroke.

Though still the number 4 cause of death in the US, stroke rates have declined over the past 20 years.

"We can congratulate ourselves that we are doing well," says Dr. Josef Coresh, professor of epidemiology at Johns Hopkins, "but stroke is still the No. 4 cause of death in the US."
Despite the promising findings, he worries that with the growing obesity epidemic and the associated hypertension and diabetes, many Americans will see an increased stroke risk.
He adds that their research "reminds us that there are many forces threatening to push stroke rates back up and if we don't address them head-on, our gains may be lost."
To conduct their study, the team used data from the Atherosclerosis Risk in Communities (ARIC) study, which is a prospective study involving 15,792 participants in the US, who were between the ages of 45-64 at the start of the study in the 1980s.
In total, the researchers followed 14,357 stroke-free people in 1987 and assessed all stroke hospitalizations and deaths between that year and 2011.

Better control of risk factors may be contributing factor

Of the study sample, 7% had a stroke during that time, and of those people, 10% died within 30 days, the team says. Additionally, 21%, 40% and 58% died within 1 year, 5 years and by the end of 2011, respectively.
Each decade, the number of deaths that occurred within 10 years of a stroke decreased by around 8 deaths per 100 cases. The team notes that this reduction was mostly due to stroke victims under the age of 65 surviving longer.
And these results were similar across all races and genders, which surprised the researchers, as a recent study suggested African-American stroke rates were not getting better.
The team discovered that the reduction in stroke incidence and mortality is related to better control of risk factors, including blood pressure, smoking cessation and the use of statins for controlling cholesterol.
Still, echoing Dr. Coresh fears, the researchers say a boost in diabetes most likely worked against stroke rates, pushing them up - but to a lesser extent. Although the study could not account for the exact role they played, the team says stroke severity and treatment improvements likely affected the outcome.
Dr. Silvia Koton, a visiting faculty member at Johns Hopkins, says:

"Stroke is not only one of the main causes of death, but a leading cause of long-term disability in adults. Therefore, prevention is the best strategy."

US stroke deaths fell 30 percent over past decade

There is absolutely no excuse not to know why this decrease is occurring, our stroke associations have no excuse for not knowing all these details.
http://medicalxpress.com/news/2013-12-deaths-fell-percent-decade.html
Experts unsure exactly why, but better prevention and after-stroke care may be factors.
Stroke deaths in the United States have been dropping for more than 100 years and have declined 30 percent in the past 11 years, a new report reveals.

Death in hospital after stroke

More stupidity, of course people die in the hospital following tPA administration. They have done nothing to stop the neuronal cascade of death. And until that is acknowledged and treated people will continue to die. Damn, must I point out the obvious over and over again.
http://www.tele-management.ca/2013/08/death-in-hospital-after-stroke/
A study looks at the factors that influence death in the hospital after a stroke.
Treatment with clot-busting drugs such as tissue plasminogen activator (tPA) is now accepted to be a good way of treating an acute stroke. Nevertheless, some patients having this treatment still die in hospital. Researchers at the University of Muenster, Germany, have been looking at the factors which influence the outcome for patients having tPA treatment for stroke.
They looked at 1,628 patients admitted with acute stroke in Germany during 2000 and 2002. Of those who were treated with tPA, ten per cent died while in hospital – with around two thirds of the deaths occurring within seven days of admission.(sounds exactly like the neuronal cascade of death) The factors affecting the risk of death were older age and altered level of consciousness on admission(completely wrong conclusion). And the researchers also noted that the more experience the hospital had in using tPA, the less the risk of in-hospital death after treatment. The researchers say that those who are most at risk of death, even after clot-busting treatment for stroke, will need to be given extra attention in hospital.

Understanding the Remarkable Decline in Stroke Mortality in Recent Decades

You can have your doctor explain the excuses behind this and ask what they are doing to stop the neuronal cascade of death. That would save a bunch of people from dying.
http://stroke.ahajournals.org/content/44/4/949.extract.html?etoc

Midlife Stroke a Harbinger of Early Death

There is absolutely no way I'm going to die early because some stupid statistician ran some calculations. I've got way too much living to do .
Video discussing it at the link. My stroke was at 50 years 3 months, I'm now 57. 
http://www.medpagetoday.com/Cardiology/Strokes/37967
A stroke or transient ischemic attack by age 50 at least triples mortality risk over the subsequent decades, a Dutch study showed.
Adults who initially survived such an event faced mortality rates of up to 3% at 1 year, 12% at 10 years, and 27% at 20 years, Frank-Erik de Leeuw, MD, PhD, of the Radboud University Nijmegen Medical Centre in Nijmegen, the Netherlands, and colleagues found.
The risk was 2.6- to 3.9-fold higher than in the matched general population without stroke, the researchers reported in the March 20 issue of the Journal of the American Medical Association.
Vascular causes accounted for half of the deaths in the decades after a midlife stroke, suggesting that the underlying vascular disease that caused the stroke presented a lifelong risk, the group pointed out.
Thus, "secondary prevention after stroke in young adults is a long-term, and probably lifelong endeavor," Graeme Hankey, MD, of Australia's Royal Perth Hospital, concluded in an accompanying editorial.
For clinicians, that means recognizing the substantially-elevated risk and then acting to treat factors like atherosclerosis, atrial fibrillation, valvular heart disease, and smoking.
"If elimination of the cause is not possible, long-term follow-up and control of the disease and its risk factors need to be maintained vigilantly," Hankey wrote.
While the results weren't surprising, they also add to the impetus to tackle risk factors in young adults to keep stroke from happening in the first place, Irene Katzan, MD, a neurologist at the Cleveland Clinic, commented in an interview with MedPage Today.
The incidence of stroke before age 55 is on the rise, now accounting for nearly 20% of strokes overall in the U.S. population, according to a recently reported analysis that likewise speculated on a shift in risk factors as the cause.
"Young" stroke has been considered to have a relatively benign prognosis because of the much lower mortality than in older adults after stroke, de Leeuw's group noted.
Because of that longer life expectancy, the group looked at long-term outcomes in the prospective Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study.
It included 959 consecutive patients, ages 18 through 50, admitted to a single academic medical center for a first-ever transient ischemic attack (TIA, 262), ischemic stroke (606), or intracerebral hemorrhage (91) from 1980 through late 2010.
In the first 30 days after the event, the fatality rate was 0.4% for TIA, 3.6% for ischemic stroke, and 22% for hemorrhagic stroke, or 4.5% overall.
At 1 year, the cumulative mortality rate for 30-day survivors was 1.2% for TIA, 2.4% for ischemic stroke, and 2.9% for intracerebral hemorrhage.
The annual mortality risk after TIA didn't go up much, if any, over time, but the cumulative mortality of even these "mini-strokes" was substantial at 9.2% after 10 years and 24.9% after 20 years.
After ischemic stroke, the annual mortality risk remained fairly constant over the years, with a cumulative risk of 12.4% after 10 years and 26.8% after 20 years.
The smaller number of hemorrhagic stroke patients who survived to 30 days resulted in a more variable annual mortality risk ranging from less than 1% to nearly 3%.
But their long-term cumulative risk was lower than in the first 30 days, at 10.3% after 10 years and 13.7% after 20 years.
The mortality risk over the entire follow-up period compared with an age-, sex-, and year-matched cohort from the no-stroke general population in the Netherlands was consistently elevated after ischemic stroke (26.8% versus 7.6%), though only significantly higher after 10 years post TIA (24.9% versus 8.5%).
Confidence intervals for long-term mortality after intracerebral hemorrhage overlapped with expected rate for the general population.
Introduction of thrombolytic therapy toward the end of the study period didn't appear to impact later mortality risks.

Higher density of neurologists and neurosurgeons 'lowers risk of stroke death'

Two articles for you to peruse. I highly doubt that the density of neurologists has much to do with lowering the risk of stroke death.  Nothing in here that compares immediate stroke deaths vs. 30 day deaths. and no speculation as to why.
Higher density of neurologists and neurosurgeons 'lowers risk of stroke death'

Researchers find association between neuroscience providers and stroke-related deaths in US