Cerebral infarctions and reasons for the increase in incidence worldwide

About one in 10 people worldwide die from stroke, which is the third leading cause of death in the world after heart disease and COVID-19 and the fifth leading cause of death in the United States. In Spain it is “the third global cause of death in our country (to
after COVID-19 and coronary heart disease), second in women and fourth in men,” the report says. National Health System Strategy for Stroke 2024.

Deaths from cardiovascular disease, including stroke, fell in the second half of the 20th century, but the decline slowed and then stopped in 2015, a global analysis shows. Although low- and middle-income countries have the highest incidence of stroke overall, there has been an increase in incidence over the past decade due to ictus young people in several high-income countries.

Rising risk factors range from rising obesity rates to warmer temperatures due to climate change, but the biggest risk factor is the same in every region of the world: high blood pressure, responsible for a slightly higher proportion of all strokes, study finds Lancet. Another study published last month in The JAMA Network is open found that more than half of all Americans with high blood pressure don’t even know they have hypertension, including 93 percent of people ages 18 to 44.

Fortunately, of all the risk factors for stroke, hypertension is the easiest to control and modify.

“If you want to do one thing all over the world, from the harshest corners of Africa and Southeast Asia to the skyscrapers of New York, it’s the same thing: take your blood pressure,” says Mateo Schrag, a neurologist. from Vanderbilt University Medical Center (USA). Healthy blood pressure is a reading below 120/80, which can be achieved with lifestyle changes and medications.

“We have dozens of medications that are incredibly effective and cheap, and you can monitor your blood pressure at home with a device for around 20 euros and no experience is required to use it,” says Schrag. “The time has come for a serious public health impact on hypertension. This will not only prevent strokes, but will also prevent heart attacks and many other problems.”

People with very high blood pressure are not the only ones at risk. Valery Feigin, a stroke researcher at the University of Auckland in New Zealand who led the global study Lancet says that most ictus and heart attacks occur in people with moderately high blood pressure. Every millimeter (top number) reduction in systolic blood pressure at the population level is associated with a reduction in stroke incidence of about 10 percent. “When you only target high-risk people, you miss a large portion of the stroke population,” he says.

Among more than 5.2 million adults surveyed between 2011 and 2022 for a CDC report released in May, the proportion who had previously had a stroke increased from 2.7 percent in 2011-2013 to 2.7 percent in 2020-2022. While this increase may seem modest, it reverses the decline in stroke rates seen over the previous decade, and analysis of these data reveals a more nuanced story.

The researchers counted the number of living people who had previously had a stroke, rather than the number of new strokes occurring each year. The figures therefore include an increase in the number of people who have strokes and are living longer, as well as an increase in the number of new strokes in subgroups of the population.

Although advanced age is a known risk factor ictusthe prevalence has not actually increased among adults aged 65 years and older. The age group with the largest increase was 45 to 64 years old, up half a percentage point, representing a 16 percent increase. Among adults aged 18 to 44, the prevalence of stroke also increased by one-tenth of a percentage point, representing a relative increase of 15 percent. Simply put, young people still make up a very small part of the population. ictus overall, but rates are rising rapidly in these younger groups and no increase has been seen among older people.

Improved survival and stable outcomes for older adults are not a mystery. New medications, better treatments for chronic diseases, and better stroke care have helped people survive and prevent strokes. ictus initially and later, Feigin and Imoisili note. But for young people the picture is more complex.

“Changing trends in stroke prevalence are consistent with trends in obesity and hypertension, which are common risk factors for stroke,” says Imoisili. September data from the Centers for Disease Control and Prevention (CDC) shows how much obesity has increased in the United States over the past decade. The prevalence of obesity was highest in the South, where many states had the highest prevalence of stroke.

Native Americans, Native Hawaiian/Pacific Islanders, and Black people experienced a higher prevalence of stroke, possibly due to higher rates of chronic disease, lower income, and less access to health care, as well as barriers “such as racism or systemic inequality,” says Imoisili.

Globally, obesity’s contribution to stroke risk has increased 88 percent since 1990, although hypertension remains the leading risk factor, accounting for 57 percent of strokes worldwide, according to a New York Times study. Lancet . Air pollution, both outdoor and indoor (from burning fuels at home), is responsible for about 30 percent of strokes worldwide, but the role of air pollution has actually declined since 1990, Feigin said. In contrast, the contribution of warmer air temperatures increased by 72 percent, followed by an increase in the contribution of high blood glucose and consumption of sweetened drinks.

However, the role of ambient temperature in ictus This is not easy to determine. Despite warmer temperatures increasing the risk of stroke and increasing heat-related deaths in the US and around the world due to climate change; Extreme temperatures must be taken into account in both directions. A global study published this year and other recent studies have found that cold temperatures have a greater impact on stroke and death rates than warm temperatures.

The conclusions from these results are mixed, Schrag says. More people survive ictus and they live longer thanks to advances in intensive care and rehabilitation. But the largest proportion of survivors ictus It also comes at a high cost to society and caregivers. “That’s good, but it also creates problems,” Schrag says.

Prevention is a huge untapped opportunity. “Today blood pressure goes down, and tomorrow the incidence of strokes goes down,” says Feigin. And the vast majority of strokes are preventable, he adds.

“For people, the first step is to recognize the risk associated with lifestyle or family history,” says Richard Temes, a neurologist at Northwell Health in the US. An important lifestyle change for lowering blood pressure is reducing your sodium intake, Feigin says. Ultra-processed foods are the largest source of salt in our diets, he says. Changing one aspect of your lifestyle can have a ripple effect. “Weight, hypertension, physical inactivity, diet—all these lifestyle factors are interrelated,” he says. “You take one, make a positive change and influence others,” he advises.

Imoisili agrees. “It is important to reduce your risk of stroke by taking control of your health,” which also includes quitting smoking, limiting alcohol consumption, controlling cholesterol levels and managing chronic diseases such as diabetes.

Early detection of stroke is just as important as reducing personal risk factors for stroke, he said. “The sooner you get to a medical facility where you can receive care, the better your chances of survival,” he says. Acronym faceweapons, speech and time FAST (Face, Arms, Speech and Time) includes three signs of stroke: drooping face, arm weakness, and difficulty speaking or speaking strangely. Any of these methods means calling an ambulance immediately.

The bottom line is that people can do a lot to reverse these trends.

“We’re seeing more people in their 40s and 30s developing heart disease and stroke, and the key to that is understanding their risk and recognizing that these are things we don’t necessarily have to accept,” Temes says. He adds: “We can take proactive steps about our lifestyle and our health, and as a community we can influence our own future.”