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  • Review Article
  • Published:

Prevention of stroke: a strategic global imperative

Nature Reviews Neurology volume 12, pages 501–512 (2016)Cite this article

Subjects

Key Points

  • Although global stroke incidence and mortality declined from 1990 to 2013, the stroke burden, in terms of absolute numbers of people affected by stroke, continues to increase rapidly throughout the world

  • The ever-increasing burden of stroke suggests that current primary prevention strategies for stroke and cardiovascular disease (CVD) are not sufficiently effective

  • To improve primary stroke prevention strategies, we need to shift the emphasis from a high-risk approach to a more comprehensive approach targeting people at all levels of CVD risk

  • To be cost-effective, primary stroke prevention strategies must be integrated with prevention strategies for other major noncommunicable diseases that share common risk factors with stroke, including CVD, vascular dementia and diabetes

  • Resources for the development and implementation of culturally appropriate and population-specific primary stroke prevention strategies could be taken from revenue resulting from taxation on tobacco, salt, sugar and alcohol

  • Given the already immense and fast-increasing burden of stroke and other major NCDs, which threatens global sustainability, failure to act on primary prevention of these diseases is unacceptable

Abstract

The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.

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Figure 1: Ischaemic stroke prevalence and mortality.
Figure 2: Haemorrhagic stroke prevalence and mortality.
Figure 3: Stroke-related deaths and DALYs by country development status.
Figure 4: Burden of stroke in proportion to all health conditions.
Figure 5: Sex-related differences in stroke burden.
Figure 6: Combining population-wide and high-risk strategies.

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Acknowledgements

V.L.F. was partly funded by the Health Council of New Zealand, the Brain Research New Zealand Centre of Research Excellence, the “Ageing Well” Programme of the National Science Challenge, and the Ministry of Business, Innovation and Employment of New Zealand. G.A.R. has grant funding from the US National Institute on Ageing and Medtronic Philanthropy. We would like to thank Barbara Bowman at the Centers for Disease Control and Prevention for her valuable comments on early version of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; NIH; Centers for Disease Control and Prevention; or the U.S. Department of Health and Human Services.

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Authors and Affiliations

  1. National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupation Studies, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Drive, Northcote 0627, Private Bag 92006, Auckland, 1142, New Zealand

    Valery L. Feigin

  2. Department of Clinical Sciences, Neurology, Lund University, Paradisgatan 2, Lund, Sweden

    Bo Norrving

  3. Division for Heart Disease & Stroke Prevention, Centers for Disease Control and Prevention, 600 Clifton Road, Atlanta, 30333, Georgia, USA

    Mary G. George & Jennifer L. Foltz

  4. Institute for Health Metrics and Evaluation and the Division of Cardiology, School of Medicine, University of Washington, 2301 5th Avenue Suite 600, Seattle, 98121, Washington, USA

    Gregory A. Roth

  5. Center for Translation Research and Implementation Science (CTRIS) and Division of Cardiovascular Sciences; National Heart, Lung, and Blood Institute, National Institutes of Health,

    George A. Mensah

  6. National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, 20892, Maryland, USA

    George A. Mensah

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  1. Valery L. Feigin
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Contributions

All authors researched data for the article, made substantial contributions to discussions of the content and reviewed and/or edited the manuscript before submission. V.L.F. wrote the article.

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Correspondence to Valery L. Feigin.

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V.L.F. declares that Stroke Riskometer app is copyrighted by the Auckland University of Technology, and funds resulting from the sale of the professional version of this app will be used for further research and education for stroke prevention. The other authors declare no competing interests.

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Feigin, V., Norrving, B., George, M. et al. Prevention of stroke: a strategic global imperative. Nat Rev Neurol 12, 501–512 (2016). https://doi.org/10.1038/nrneurol.2016.107

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