Stroke is the third leading cause of death and the fourth leading cause of health loss worldwide. These data may be striking when one considers that the majority of cases, 84% are due to avoidable risk factors. Among these agents that improve it, we can find some such as air pollution, high temperatures, high blood pressure or even smoking. Despite this, the cases continue to increase. An analysis published this Wednesday in The Lancet It indicates that in 2021 (the latest damage for which there is data) 11.9 million new cases were recorded, 70% more than in 2019.
Not only have diagnoses increased, but deaths have also increased by 44% (7.3 million) and health losses due to this problem up to 32%. On the other hand, the good news that the authors bring is that the number of survivors has increased by 86% and has reached almost 94 million people worldwide. The work is part of the Global Burden of Diseases, Injuries and Risk Factors (GBD) study and the results have been published in the journal The Lancet Neurology.
Another measure considered in the research is disability-adjusted life years (DALYs). Globally, the total number of disabilities, illnesses and premature deaths due to stroke increased lost years by 32%. If in 2019 it was considered that this had caused a loss of 121.4 million years of healthy life in 1990, three decades later, there are already more than 160 million.
Researchers attribute this increase to population growth and increase in aging. They also estimate that there has been a “substantial increase in people’s exposure to environmental and behavioral risk factors.” If you look at some of the risk factors individually, you’ll notice that the most responsible agents for stroke were high body mass index (BMI) (up to 88%) and high temperatures (72%).
Carlos Tejero, a member of the Cerebrovascular Diseases Study Group of the Spanish Society of Neurology (SEN), explains that there is no single element that causes this problem. Rather, it is something multifactorial. High temperatures and air pollution, for example, are linked to other pathologies that, in turn, can increase the risk of suffering them. “A stroke would be like a square accessible by different streets,” he illustrates.
The neurologist says that, although there are several elements that predispose one to suffer from it, “destiny is the same”. He also warns of the multiple facets of the disease: “Anyone can suffer from it and find that the type of life they lead and the things that have happened to them are very different from the people around them.
Other factors that were more present in the diagnoses, according to the analysis, were: high blood sugar level (an increase of 32%) and a diet rich in sugary drinks (an increase of 23%). The factor that has increased the least as a cause of stroke is the low consumption of omega-6 polyunsaturated fatty acids, which has increased by only 5%.
Specifically, in 2021, the top five global risk factors for stroke were: high systolic blood pressure, air pollution, smoking, high LDL cholesterol, and household air pollution. Within this group, it was observed considerable variation depending on certain circumstances such as age, gender and location (patient’s area of residence).
Tejero explains that this shows that Each individual has a series of factors that cannot be changed, like these three. There is a genetic load determined by where it comes from, he illustrates. If you change location, you might be influenced by environmental factors, but those genomic conditions will always be with you.
More than three-quarters of the world’s total cases have been recorded in low and middle income countriesreport the researchers. These environments are the most affected because several factors usually come into play that increase the risk of suffering a stroke, explains the neurologist. Among other things, they tend to have a poorer quality diet, may be exposed to harmful environmental factors and have more difficult access to health services, he details.
Such work allows generating a picture that can assess the stroke situation globally. Tejero points out that this type of data can help compare incidence between territories and improve recommendations to patients. In addition, these figures also serve as a sample for health authorities in each country when asking them to solve the problem, he adds.
Spain, one of the leaders
Spain is one of the countries with the best indices and, even, reduced the prevalence of strokes in the last 31 years. It has managed to go from 54 cases per 100,000 inhabitants to 45.3. Tejero acknowledges that the situation is good, “but it could still be better.” The SEN expert says that aspects such as nutrition, universal access to health care and some preventive measures are key to this success.
Tejero says it’s also an example of how the limitations of recent decades, such as smoking restrictions, are really helping to reduce the burden of stroke. Things are going well, but there is still a lot of work to dohe adds. “As long as there are still years of life lost due to stroke, we must continue to fight.”
Specifically, the authors point out that strategies aimed at reducing exposure to certain risk factors over the past three decades, such as clean air zones and smoking bans in public places, have been successful. These smoking-related events were reduced by 13% and 20% those caused by pollution. Regarding diet, strokes linked to diets rich in processed meat and poor in vegetables have decreased by 30 and 40%.
The SEN expert states that in Spain society is aware of the problem posed by strokes, how to recognise them and how to act when it is recognised that a person is suffering from one. However, especially among young people, lack of thought on prevention and risk factors that can be avoided individually. “Each person runs their own risk and knows what habits they can change to try to reduce the possibility of suffering from it.”
The book demonstrates the urgency for all countries to implement measures “effective, accessible and affordable” improve surveillance, prevention, active care and rehabilitation of stroke. This, the authors emphasize, is the only way to reduce its incidence.
