risk factors

Strokes are largely preventable with 10 risk factors responsible for 90% of them

The two major types of stroke include ischaemic stroke caused by blood clots, which accounts for 85% of strokes, and haemorrhagic stroke or bleeding into the brain, which accounts for 15% of strokes.

TEN RISK FACTORS are responsible for nine out of 10 strokes worldwide, according to a study published in The Lancet today.

Stroke is a leading cause of death and disability, particularly in low-income and middle-income countries but the new study – which was led researchers from NUI Galway and McMaster University, Canada - found that the risk factors can be modified.

The study had collaborators from 32 countries in Europe, Asia, America, Africa and Australia, and sought to identify the main causes of stroke in diverse populations, young and old, men and women and within subtypes of stroke.

The investigators looked at the different risk factors, and determined the proportion of strokes which would be cut if the risk factor disappeared.

The number of strokes would be practically cut in half (48%) if abnormally high blood pressure (hypertension) was eliminated; trimmed by more than a third (36%) if people were physically active; and shaved by almost one fifth (19%) if they had better diets.

In addition, this proportion was cut back by 12% if smoking was eliminated; 9% for cardiac (heart) causes, 4% for diabetes, 6% for alcohol intake, 6% for stress, and 27% for lipids (the study used apolipoproteins, which was found to be a better predictor of stroke than total cholesterol).

Regional Variation

The importance of some risk factors appeared to vary by region. For example, the importance of hypertension ranged from 38.8% in western Europe, North America, and Australia to 59.6% in Southeast Asia.

The risk of alcohol was lowest in Western Europe, North America and Australia but highest in Africa and south Asia, while the potential impact of physical inactivity was highest in China.

An irregular heart rhythm, or atrial fibrillation, was significantly associated with ischaemic stroke in all regions, but was of greater importance in Western Europe, North America and Australia, than in China or South Asia. However, when all 10 risk factors were included together, their collective importance was similar in all regions.

A stroke physician at Saolta University Healthcare Group, Martin O’Donnell said:

We have confirmed that ten modifiable risk factors are associated with 90% of stroke risk in all parts of the world, in both men and women, and in younger and older people.

“The study also confirms that hypertension is the most important modifiable risk factor in all regions, and the key target in reducing the burden of stroke globally.”

Professor of medicine of McMaster’s Michael G. DeGroote School of Medicine and director of the PHRI, Salim Yusuf said, “Our findings will inform the development of global population-level interventions to reduce stroke, and how such programs may be tailored to individual regions.

This includes better health education, more affordable healthy food, avoidance of tobacco and more affordable medication for hypertension and dyslipidaemia.

New Zealand researchers Valery L. Feigin and Rita Krishnamurthi from the National Institute for Stroke and Applied Neurosciences, of Auckland’s University of Technology said the study shows that stroke is a highly preventable disease globally, regardless of age and sex.

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