The increasing tendency to focus on identifying and treating individuals classified at high-risk of stroke, for example people with 5-year risk of CVD 15% and greater, while valid is not the answer to the stroke tsunami. To be fully effective, stroke prevention strategies must include both population-wide and individual-based preventative strategies regardless of the level of CVD risk. For communicating CVD risk, categorisation of people into low, moderate and high CVD risk should be brought to an end.
The combination of risk targeted intervention and population approaches can be accomplished through the use of mobile technology which can monitor, motivate and identify risks (for example the validated and internationally endorsed Stroke Riskometer app). New techology, combined with task-shifting of prevention, from highly trained health professionals to community based health-care workers, who require less training, qualifications and can be mobilised more quickly offer a key. These strategies are particularly important for people living in Low to Middle Income Countries, or low socioeconomic groups, who are more exposed to stroke risk factors and whose access to health services often doesn't meet the WHO requirements for Universal Health Coverage.
Key Steps to More Effective Stroke Prevention
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.
Read the full article What Is the Best Mix of Population‐Wide and High‐Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? in the Journal of the American Heart Association