Primary Prevention of Stroke

After heart disease, stroke is the second leading cause of death worldwide in persons ≥15 years of age.1 Stroke was responsible for an estimated 5.7 millions deaths in 2005, with ≈87% of the deaths occurring in low- and middle-income countries. It is the fourth leading cause of disease burden as determined by disability-adjusted life-years. In the United States, stroke caused an estimated 1 in 16 deaths in 2004; ≈780 000 new or recurrent strokes occurred; and 15% to 30% of stroke survivors were permanently disabled.2 In the United States in 2008, the direct and indirect cost of stroke is estimated to be $65.5 billion. Globally, stroke death is anticipated to rise to 6.5 million in 2015 and 7.8 million in 2030.1 Although stroke poses a major public health challenge, it is preventable.3 Observational epidemiological studies and clinical trials have laid the groundwork for well-developed evidence-based stroke prevention guidelines.Article p 947 The INTERHEART study helped to clarify the role of traditional cardiovascular risk factors in coronary heart disease among 15 152 cases of acute myocardial infarction and 14 820 controls in 52 countries on every inhabited continent.4 This important observational epidemiological study showed that for men and women, old and young, and in all areas of the world, 9 potentially modifiable factors accounted for >90% of the proportion of the risk of initial acute myocardial infarction. The factors were abnormal lipids; smoking; hypertension; diabetes; abdominal obesity; psychosocial factors; consumption of fruits, vegetables, and alcohol; and regular physical activity. Because coronary heart disease and stroke share common risk factors,5 a combination of healthy lifestyle factors also might influence stroke risk. There has been a relatively paucity of information, however, in this area of study.In this issue of Circulation , Chiuve et al6 report …