World Stroke Organization on Stroke and Dementia

In June 2020, The Lancet Neurology published a very important Declaration proclaimed by the World Stroke Organization (WSO) on stroke and dementia.

The WSO predicts that by 2050, about 200 million stroke survivors will be in the world. And because of the close link between stroke and dementia, we could expect about 106 million living with dementia; and, thereafter, each year, we may encounter over 30 million new stroke patients.

The most notable statement, to me, in their declaration, is this:

The current strategies to address risk factors for heart diseases and stroke are not sufficiently effective.

World Stroke Organization, June 2020; https://www.world-stroke.org/assets/downloads/Global_prevention_of_stroke_and_dementia_WSO_declaration.pdf

Rather than finding why they say this, I focus my attention on what they propose to do.

Let us find out what they have to say about this.

First of all, it is worthwhile to note that they recommend a common prevention strategy for both stroke and dementia because both problems share the same risk factors.

And, these risk factors contribute not only to stroke and dementia but other leading non-communicable diseases also.

What are those?

  • Elevated blood pressure
  • Abnormal blood lipid levels
  • Smoking
  • Alcohol
  • Physical inactivity
  • Salt and sugar
  • Unhealthy diet

As we can see that the above risk factors fall into two broad categories;

  • Biological (elevated blood pressure and abnormal lipid levels)
  • Behavioral or lifestyle; however, behavioral risk factors in turn contribute to elevated blood pressure and abnormal lipid levels.

Now let us look at what the World Stroke Organization (WSO) suggests doing differently to address those risk factors.

A paradigm shift:

Abandoning graded risk categorization and adoption of a risk continuum scale

The first is that their appeal for a paradigm shift of risk classification; they recommend abandoning mild, moderate, and high-risk categorization for heart and stroke problems; instead re-framing stroke risk along a continuum.

Population-wide prevention strategies

They underscore the need of adopting a population-wide approach to reduce the negative impact of behavioral (lifestyle) risk factors. Quite correctly, they also emphasize the need for integrating into the WHO HEARTS initiative, and the establishments and programs at all levels, global, national, and local.

Individual level interventions

Of course, individual interventions – screening for risk behaviors – also necessary; more specifically, poor diet, physical inactivity, alcohol use, and smoking and biological risk factors – elevated blood pressure and abnormal lipid profiles.

The WSO has introduced a free stroke riskometer app to aid this intervention strategy.

Combining community interventions with medicines and behavioral interventions for people at risk of stroke

They highlight five lifestyle risk factors (smoking, physical activity, diet, alcohol consumption, weight) based on evidence.

Implementation strategies

The WSO suggests several evidence-based implementation strategies. These are as follows;

Author: Prasantha De Silva

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