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A Declaration on the stroke 'pandemic'

Photo: A Declaration on the stroke 'pandemic'
“COVID-19 has spurred government interventions and individual behaviour change on a global scale that was previously inconceivable, yet we have effectively been living with a stroke pandemic for years,” says Professor of Epidemiology and Neurology, Valery Feigin, at Auckland University of Technology (AUT).

Professor Feigin, Director of the National Institute for Stroke and Applied Neurosciences at AUT, is a co-author of the World Stroke Organization (WSO) Declaration on Global Prevention of Stroke and Dementia, published in the latest edition of The Lancet Neurology.

It calls for urgent action from governments to address failing public health prevention efforts.

Without new evidence-based interventions, the WSO projects that annual deaths from stroke and dementia will reach 12 million and five million respectively, by 2050.
Professor Feigin says, the need for radical action is clear.

“If implemented globally, the interventions we are proposing would not only save millions of lives, but hundreds of billions of dollars annually. This money is desperately needed to strengthen global health systems and fuel economic recovery in the wake of COVID-19,” he says.

An important way to control stroke and dementia is to focus on reducing the risk factors associated with these diseases.

Low-cost solutions exist for governments and other stakeholders to reduce the common modifiable risk factors, avoiding the need for more expensive treatment, says Professor Feigin.

The Declaration outlines four interdependent interventions:

  1. Population-wide strategies to reduce exposure to stroke risk factors and environmental risk factors across the entire lifespan – (ie: smoking cessation campaigns, reducing salt and sugar in processed foods, and restricting alcohol consumption). 
     
  2. Motivational strategies using mobile technologies to identify individual risk and promote behaviour change among adults – (ie: the WSO endorsed AUT Stroke Riskometer mobile app).
     
  3. Access to low-dose blood pressure and lipid-lowering medication in one polypill for middle-age and older adults.
     
  4. Investment, training, and deployment of community health workers to implement public health prevention strategies.

The WSO estimates that this recommended population-wide approach would reduce the incidence of stroke by 50 percent, while also addressing numerous other Non-Communicable Diseases (NCDs) that share common risk factors.

NCDs are a major risk for patients with COVID-19. The pandemic has revealed the particular vulnerability of those with underlying conditions.

Professor Feigin is considered one of the world’s most influential scientific minds. He ranks among the top one percent of scientists by citations for global research on the epidemiology, management, and prevention of stroke and traumatic brain injury.

“If the COVID-19 response is not adapted to encompass prevention and management of common stroke and NCD risk factors, we may fail many people at a time when their vulnerability is heightened,” he says.

Evidence from this and previous pandemics suggests that without proper management, chronic conditions can worsen due to stressful situations, as a result of restrictions, insecure economic situations, and changes in health behaviours. 

Modifiable behavioural risk factors (smoking, physical inactivity, unhealthy diet, harmful use of alcohol) and metabolic risk factors (hypertension or high blood pressure, and obesity) increase the risk of stroke, dementia, and NCDs.

New Zealand has the second highest lifetime risk of stroke (26 percent) among developed countries, ahead of Canada (24 percent), the United States (23 percent), United Kingdom (21 percent), and Australia (21 percent). The highest is Finland (29 percent).

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