Further Good News on Stroke, but No Time for Rest

Progressive reduction in stroke deaths over the last few decades has resulted in the recent preliminary announcement that stroke has declined from the third to the fourth-leading cause of death in the United States.1 Moreover, the 2010 American Heart Association goal of reducing coronary heart disease and stroke mortality by 25% in the first decade of this century was achieved early, with a 30.7% reduction in CHD mortality and a 29.2% reduction in stroke mortality from 1999 to 2008.2Article see p 2111Stroke incidence also appears to be declining. Two population-based studies in the United States3 and United Kingdom4 have demonstrated an age-adjusted decrease in stroke incidence. The rise in the number of primary and comprehensive stroke centers in the United States, increasing use of acute stroke therapies, and greater availability of evidence-based approaches to prevent and treat stroke have undoubtedly had a favorable impact on these improving trends.5Less is known about temporal trends in recurrent stroke risks. Of the estimated 795 000 annual strokes in the United States, 23% are recurrent events.6 In this issue of Circulation , Hong et al7 have provided important data on trends in the risk of recurrent stroke over the last 50 years. They performed a study-level systematic review of the control arms of secondary stroke prevention randomized, controlled trials with broad inclusion criteria, excluding trials that tested interventions directed at specific stroke mechanisms, such as atrial fibrillation or carotid or intracranial stenoses. In total, 59 trials and 66 157 patients in control arms were analyzed. Significant absolute average declines of 1% per decade for annual rate of recurrent stroke, 0.3% for fatal recurrent stroke, and 1.3% for major vascular events were estimated.Other …