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
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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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.
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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