Advances in Primary Prevention and Health Services Delivery

The American Heart Association’s goal of reducing deaths from coronary heart disease and stroke in the United States by 25% between 1999 and 2010 was achieved in 2008—a remarkable accomplishment associated with advances in stroke prevention and treatment. Yet, much work remains to be done. Stroke is still the third most common cause of death in the United States and other developed nations, and is the leading cause of death in middle-income countries.1,2 From 1979 to 2005, the number of inpatient discharges from short-stay hospitals in the United States with stroke as the first listed diagnosis increased 20% to 895 000.1 Prevention remains the cornerstone of efforts to reduce the burden of stroke on populations throughout the world, with much to be gained through better adherence to proven stroke prevention measures.3Primordial prevention refers to societal and other efforts aimed at reducing the likelihood that persons will develop the risk factors that can lead to disease. In Scotland, a ban on tobacco smoking in public indoor spaces was enacted into law in March 2006. Although data for an effect on stroke risk is not available, a study focused on hospital admissions for acute coronary syndromes demonstrated the potential impact of such legislative efforts.4 Information on smoking status and exposure to secondhand smoke was collected prospectively based on questionnaires and biochemical findings from all patients admitted with acute coronary syndromes to 9 Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the following year. The numbers of admissions for acute coronary syndromes decreased by 17% (95% CI, 16% to 18%) as compared to a 4% reduction in England (which has no smoking ban) over the same period. Persons who had never smoked reported a decrease in the weekly duration …