Friday, February 3, 2017

Why Stroke Prevention Needs Overhaul

Tackling the world’s second biggest killer requires new approaches to prevention and risk management says World Stroke Organization Board Member Prof Valery Feigin.

The past 25 years have seen the global burden of stroke rise exponentially. Stroke is increasingly affecting low and middle income, with an incidence pattern that shows significant differences based on gender and ethnicity and an increasing number of strokes among younger people. Despite all our best efforts around primary stroke prevention our current approaches to prevention, screening and risk management clearly aren’t hitting the mark.

Prof Feigin advises that we need to take the following key steps to get us closer to a world free from stroke.

1          Increase awareness
Despite being the second biggest killer globally, public awareness of stroke risks and how to manage them is still low. Coordinated global and national campaigns that raise awareness of how to reduce and manage individual stroke risks have the potential to deliver significant gains in stroke prevention.

2          Drop the ‘low risk’ category
80% of strokes happen to people who are considered to be at low absolute risk of stroke. We need to encourage everyone to take stroke risk seriously. Telling someone they are ‘low risk’ gives false reassurance and doesn’t provide the motivation people need to take the risks seriously and take steps to address them.

3          Manage high blood pressure
Uncontrolled high blood pressure increases a person's stroke risk by four to six times. Addressing high blood pressure as a contributing factor to stroke would result in a significant reduction in strokes. However, the decision on whether to treat for high blood pressure is currently based on an overall calculation of high-risk cardiovascular disease. Someone with hypertension may not receive treatment because their overall five-year risk of CVD is less than 15%. We need to look at this.

4          Improve screening tools
Despite the fact that nearly three quarters of the global burden of stroke is attributed to lifestyle factors with the exception of smoking, current stroke screening tools don’t include a number of key lifestyle factors. We need to improve our screening tools to include behavioural risk factors such as poor diet, obesity, activity levels and alcohol intake.

5          Become diversity sensitive
Globally and within countries our populations are increasingly diverse. But the models we use to predict levels of risk are largely based on the Framingham study the subjects of which were largely white, North American. Addressing the significant differences in stroke rates across ethnicities and gender is going to require tools that can better predict stroke risks for specific populations so that these can be more effectively managed.

6          Deliver affordable solutions
The cost of seeing a doctor for CVD assessment, lab tests and medications that may reduce stroke risk can be a significant barrier for individuals who lack financial means in high, low and middle income countries. Low cost risk assessments and management strategies are essential.

Mobile technologies offer promising, accessible, motivational, educational and validated stroke prevention tools for both patients and healthcare workers that we need to explore and develop.

7          Implement population wide preventive strategies
Despite clear evidence of the effectiveness of population wide strategies, there is still not a single country in the world that has implemented these in full on a population level. Taxation of tobacco, sugar and alcohol would not only address incidence of stroke they would provide revenue to support research, development and implementation of culturally appropriate approaches to primary prevention.

8          Build partnerships and advocacy
If we are going to achieve the kind of changes and interventions that are needed to drive positive behaviours, we need to build partnerships between healthcare, and government and provide the evidence to support stronger advocacy from NGOs.

This article is based on an article by Prof Valery Feigin published in Volume 12 Issue 1 of the International Journal of Stroke. Professor Feign is Director of AUT’s National Institute for Stroke and Applied Neuroscience (NISAN) and a World Stroke Organization Board Member.

WSO members receive the IJS free as part of their membership. Find out more about becoming a WSO member here.  Alternatively you can explore content and subscription options on the publisher’s website.

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