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Striking Out Against Stroke

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Published Online: Jun 4th 2011 European Neurological Review, 2006;6(1):59-62 DOI:
Authors: Arne Hagen
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Stroke is the term applied to the sudden death of brain cells when a blockage or rupture of an artery impairs blood flow to the brain. Typically, a clot forms in a small vessel in the brain that has been narrowed due to long-term damage. Stroke may also result from:
• a blood clot or fatty deposit breaking lose and lodging in an artery of the brain, thus stopping the flow of blood;
• a blood clot forming in the chamber of a heart that is beating irregularly, breaking off and forming a plug in the brain artery; or

Stroke is the term applied to the sudden death of brain cells when a blockage or rupture of an artery impairs blood flow to the brain. Typically, a clot forms in a small vessel in the brain that has been narrowed due to long-term damage. Stroke may also result from:
• a blood clot or fatty deposit breaking lose and lodging in an artery of the brain, thus stopping the flow of blood;
• a blood clot forming in the chamber of a heart that is beating irregularly, breaking off and forming a plug in the brain artery; or
• bleeding in the brain caused by the widening and weakening of a blood vessel in the brain.

The Effects of Stroke

In its acute stages, stroke represents a medical emergency and the fatality rate is high. Survivors of stroke have complex care needs, may suffer long-term disability and may need admission to long-term care. Data from the UK indicate that approximately 30% of patients die in the first month after a stroke, 35% are still significantly disabled after one year and 5% have to be admitted to long-term residential care.
Depending on which part of the brain that is affected and how widespread the damage is, the effects of stroke can include difficulties in movement, balance, walking, swallowing, speaking, dressing, feeding, controlling bladder or bowel movements, vision and mood. Stroke survivors also experience much higher rates of depression than non-stroke patients. In a four-year study of stroke survivors, no one reported that their life had returned to normal.

Risk Factors for Stroke

High blood pressure (hypertension) is the leading risk factor for stroke and is present in the majority of stroke sufferers. In many cases, it is the only risk factor identified in people who go on to have a stroke. The risk of stroke increases the longer a person has uncontrolled hypertension and the higher the level of blood pressure is allowed to climb. Worryingly, patients and the general public alike underestimate the seriousness of hypertension, with two-thirds stating that it was not a serious health concern to them. Other identifiable risk factors for stroke include obesity, type 2 diabetes, high cholesterol levels, smoking, heavy alcohol consumption and the use of recreational drugs, such as cocaine, amphetamines and ecstasy.
While often considered a disease of ageing, approximately one-third of strokes occur in patients under 65 years of age. Stroke events are more common among low-income groups.

Incidence of Stroke in Europe

Stroke is the third leading cause of death in Europe, after heart disease and cancer, and the most common cause of adult physical disability, with an estimated 1.4 million stroke deaths each year. By way of comparison, hypertension is 60% more common in Europe than on the North American continent, and stroke is also approximately 60% more common in Europe. Globally, the World Health Organization (WHO) estimates that by 2020, heart disease and stroke will become the leading causes of both death and disability worldwide, with the number of fatalities projected to increase to over 20 million a year and by 2030 to over 24 million a year.

The Economic Impact of Stroke

Stroke imposes a significant burden on society and healthcare budgets, accounting for 3–4% of the total healthcare costs in Western European countries. Eastern and Central European countries have higher stroke rates, and with the forecast growth in Europe’s older populations, incidence across Europe is set to rise, with a corresponding impact on healthcare budgets.

Preventing Stroke

The good news is that of all neurological diseases, stroke is the most preventable one. In fact, research shows that two-thirds of physicians consider most first strokes to be avoidable.
Three steps that can help reduce the stroke risk are:
• to have regular blood pressure checks;
• to speak to a physician about appropriate treatment for hypertension, diabetes and high cholesterol levels; and
• to make lifestyle changes to improve overall health (such as losing weight, increasing physical activity or giving up smoking).
Even a modest reduction in blood pressure pays large dividends, with as many as four in 10 strokes considered preventable.

Further Steps

The EU and its Member State governments need to do more through direct intervention in healthcare to reduce the incidence of stroke and its devastating impact on patients, their families and the economy.

Raising Awareness of Stroke Prevention

More work needs to be carried out in raising awareness of the link between stroke and hypertension, as well as other contributing risk factors for stroke, and the EU should facilitate the sharing of information and best practices between Member States to develop national stroke prevention strategies across Europe.
Realistic targets should be established for stroke reduction across Europe, and progress should be regularly measured and evaluated. Data should be collected on risk factors, incidence, prevalence and the impact on healthcare economics. Member States should be made aware of the clear economic and social benefits of preventive treatment, and should recognise the true financial impact of failing to take early preventive action. Governments should promote programmes for healthy lifestyles and educate people on other risk factors for stroke, such as obesity, high cholesterol levels, smoking and lack of physical activity.

Ensuring Effective Preventive Treatment

Should lifestyle changes be ineffective, there are proven preventive treatments to reduce stroke in hypertensive patients (e.g. angiotensin receptor antagonists), but access to the most appropriate treatments can be patchy across Europe. The EU should ensure that its citizens do not experience inequalities in access to these important and potentially life-saving treatments. Healthcare professionals need to ensure that best practice is implemented in the management of hypertension and diabetes. Guidelines should recognise anti-hypertensive treatment specifically for stroke risk reduction beyond blood pressure control.
National education programmes should be established to communicate the link between hypertension and stroke and to communicate the importance of early primary stroke prevention in hypertensive patients. Such educational programmes should also focus on the underlying causes for hypertension, as well as lifestyle-related risk factors for stroke.

Improving Acute Treatment and Care for Stroke Survivors

More specialised stroke units are needed in much the same way as coronary care units were established more than 20 years ago. It has been shown that acute interventions as well as specialised, dedicated care for acute stroke victims can not only be lifesaving, but also result in long-lasting and substantial decreases in long-term disability. In addition, the disease burden for carers can be minimised when comparing stroke unit care to the care offered on general medical wards.

Stroke Alliance for Europe

Stroke Alliance for Europe (SAFE)2 represents a range of patient groups from across Europe whose mutual goal is to drive stroke prevention up the European political agenda and prevent the incidence of stroke through education. SAFE was launched in October 2004, and was born out of a workshop held in the European Parliament in June 2003 that led to a declaration calling upon the EU and its Member States to tackle stroke as a preventable catastrophe.
SAFE’s aim is to:
• promote awareness and understanding of stroke;
• promote prevention of stroke;
• identify those at risk of stroke;
• improve access to appropriate treatment and care for persons affected by stroke;
• improve the quality of life of people affected by stroke and their families;
• promote better access to accurate and understandable information about stroke;
• increase the priority given to stroke by policy- and decision-makers as well as by healthcare providers;
• promote research in stroke-related areas; and
• co-ordinate the efforts of national stroke patient groups in Europe.
By combining the resources of patient organisations across Europe, SAFE is working to champion stroke prevention, save lives and suffering, and save the European economy millions of euros in healthcare costs. The association will also encourage the creation of national stroke patient groups in Europe where none yet exists. ■



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