Population-based approaches for reducing stroke risk: an update on their success and the challenges ahead

ABSTRACT

Introduction

Stroke is a significant public health challenge as it is the second most common cause of death and the third leading cause of disability globally. Additionally, stroke incidence and the number of stroke deaths have been rising. Efforts to prevent stroke have been made, including high-risk approaches where patients are screened for cardiovascular risk factors, and population-based approaches which attempt to reduce stroke rates by improving overall population health.

Areas covered

We summarize studies of population-based approaches to stroke prevention involving greater than 1,000 participants identified on a PubMed database search. Based on these programs, challenges of population-based stroke prevention programs are discussed and potential keys to success are highlighted.

Expert opinion

Population-based stroke prevention programs face challenges including cost and interest of the public and certain stakeholders. Additionally, secular trends for improvement in risk factors and catastrophic adverse environmental circumstances add to the complexity of analyzing program success. Factors leading to successful programs include validated digital solutions for self-monitoring of risks, backing by global policy and legislation, flexibility to the needs of the population, intersectoral programs, community engagement, information dissemination back to the populations, and high-risk screening to develop a complementary combination approach to stroke prevention.

KEYWORDS:

• Cardiovascular disease
• community-wide
• population-based
• public health
• stroke prevention

Article highlights

• Stroke is the second most common cause of death and the third leading cause of disability worldwide, and the number of strokes and stroke deaths has risen consistently in past years.

• The majority of strokes are first strokes, highlighting the substantial need for stroke prevention.

• The high-risk or individual approach to stroke prevention advocates screening individuals who are at increased risk for stroke and require intervention (medications, lifestyle modifications, etc.) to reduce their risk.

• The population-based or mass approach to stroke prevention aims to reduce stroke risk in entire communities in many ways including through educational campaigns, legislation, and promotion of healthy behaviors and lifestyles.

• Challenges are faced by population-based stroke prevention programs, including cost, public and stakeholder interest, and external factors that complicate the analysis of program success such as secular trends in improving health.

• Review of these programs highlights important components that lead to successful interventions, such as digital technologies, global policy and legislative backing, flexibility to community needs, the use of pre-existing and intersectoral structures, community involvement, dissemination of program results, and a complementary combination approach incorporating high-risk screening and intervention.

Abbreviations

Apo	=	Apolipoprotein
CHAP	=	Cardiovascular Health Awareness Program
CVA	=	Cerebrovascular Accident
DALY	=	Disability Adjusted Life Year
FCHP	=	Franklin Cardiovascular Health Program
GBD	=	Global Burden of Disease
HLD	=	Hyperlipidemia
HTN	=	Hypertension
LDL	=	Low Density Lipoprotein
MHHP	=	Minnesota Heart Health Program
NKP	=	North Karelia Project
NSF	=	National Stroke Foundation
PAR	=	Population Attributable Risk
PHHP	=	Pawtucket Heart Health Program
VIP	=	Västerbotten Intervention Programme
WHO	=	World Health Organization
USA	=	United States of America

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to thank Caralee Witteveen-Lane for their invaluable assistance with the literature search for this article.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.