Changes in Stroke Epidemiology, Prevention, and Treatment

Stroke is arguably the most feared cardiovascular event among healthy subjects and those with cardiovascular disease. Recent studies document changes in the epidemiology of stroke, both within and beyond the United States, which will impact medical service needs. Advances in our treatments for primary and secondary prevention herald an exciting period of change, which promises to lower stroke rates.In the United States, as with other industrialized countries, stroke rates, adjusted for age, declined over the last 30 years.1–3 However, the aging population implies that absolute numbers of stroke may stabilize or increase over the next 2 decades.4 These changes in population demographics and overall risk of disease will place demands on health services for both acute stroke care and long-term care associated with more severe loss of function. New risk scores can risk-stratify patients presenting with stroke and provide insights into the likelihood of long-term disability.5 The temporal changes will also impact future trials of stroke prevention, because lower rates of stroke in usual care groups will drive larger sample sizes for trials evaluating new therapies.6The global perspective is quite different. Continuing industrialization of Asia and Africa is increasing unhealthy lifestyles, which promote stroke and other cardiovascular disease. As a result, the highest rates of stroke mortality and disability-adjusted life years lost occur in Asia, Russia, and Eastern Europe.7 Stroke is increasing rapidly in Eastern Europe and Central Asia compared with Western Europe3 and the United States.1,2 In China, rates of stroke and other cardiovascular disease are projected to increase dramatically due to combination of an aging population and the high prevalence of smoking and hypertension.8The types of stroke are also changing in rapidly developing Asian countries such as China, with an increase in ischemic …