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Stroke Prevention Efforts Pay Off

Stroke Prevention Infographic
Stroke Prevention Infographic

By Lindy Keane Carter

American stroke specialists are celebrating one of the ten greatest public health achievements of the 20th and 21st centuries with the welcome news that stroke has fallen since 1900 from the third leading cause of death in the US to the fourth. Daniel T. Lackland, DrPH, Professor in the Division of Neurology, Department of Neurosciences at the Medical University of South Carolina (MUSC), chaired the writing committee appointed by the American Heart Association (AHA) Stroke Council and other organizations to identify the reasons why. The committee’s findings are reported in a scientific statement published in the January 2014 issue of the AHA journal, Stroke.1

“The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” says Dr. Lackland, President-elect of the World Hypertension League. “We now have evidence that the effort people put into lowering their blood pressure, stopping smoking, controlling cholesterol and diabetes, exercising, and eating less salt has paid off with a lower risk of stroke.”

The decline occurred even while deaths resulting from heart diseases increased between the years 1900 and 1968.

The investigators identified efforts initiated in the 1970s to control hypertension as having the most influence on the decline of strokes and stroke death. Improved control of diabetes mellitus and dyslipidemia (abnormal cholesterol and fat levels in the blood) and smoking cessation programs also contributed, but the role of these interventions is less clear because they began after the 1970s. Other factors associated with changes in stroke risks cited in the statement include systems of care, acute stroke care and treatment, air pollution exposure, health behaviors, and clinical management of stroke-risk conditions such as atrial fibrillation.

Across the US, stroke deaths dropped in men and women of all racial/ethnic groups and ages. Even in the Southeast, known as the Stroke Belt because of more cases of hypertension and more severe hypertension, stroke mortality rates fell. This was attributed to aggressive public health education programs that were implemented throughout the 11 states in the Stroke Belt. However, racial and ethnic group disparities still exist, Dr. Lackland explains. “We need to keep doing what works and to better target these programs to groups at higher risk.”

Learning more about the specific factors and interventions that have proven successful in reducing stroke will be increasingly important to clinicians, public health officials, and policy makers as they build prevention strategies for the future. The cost of treating stroke is predicted to more than double in the next 20 years, according to an AHA/American Stroke Association policy statement written by Bruce Ovbiagele, M.D., MSc, MAS, Chair of the Division of Neurology, Department of Neurosciences at MUSC.2 In the statement published in the August 2013 issue of Stroke, Dr. Ovbiagele writes that costs may increase from $71.55 billion in 2010 to $183.13 billion in 2030, not counting the cost of lost productivity. This is due to America’s aging population, as individuals between ages 45 and 64 have the highest risk of stroke.

References

1 Lackland DT, Roccella EJ, Deutsch AF, et al; for the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Quality of Care and Outcomes Research, and Council on Functional Genomics and Translational Biology. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014 Jan;45(1):315-53.

2 Ovbiagele B, Goldstein LB, Higashida RT, et al. Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association.Stroke 2013 Aug: 44(8): 2361-75.