MD Conference Express ISC 2013 - (Page 11)
Stroke Update: An Overview of What
Is Going on in the Area of Stroke
Written by Mary Beth Nierengarten
During an invited symposium at the 2013 International Stroke Conference, investigators shared
their thoughts on key areas in stroke research that will shape the field in a number of ways.
WORLDWIDE BURDEN: NEED FOR BETTER PREVENTION OVER A LIFETIME
Lewis B. Morgenstern, MD, University of Michigan, Ann Arbor, Michigan, USA, opened the
session with an epidemiological look at stroke mortality and its global health burden. Citing a
recently published article that looked at 20 years of mortality data from 1990 to 2010 [Lozano R et
al. Lancet 2012], he highlighted that stroke has remained the second most common cause of death
worldwide and that the mortality rate has increased by 26% over 20 years. Even more sobering, he
said, is the 177% increase over 20 years in the global years of life lost due to stroke.
Although stroke incidence and mortality are declining in the West, the burden of stroke remains
robust and unchanged or increasing for the poor and minorities. This indicates that it is increasingly
becoming a disease of the poor and underserved populations.
Given the disparities, Dr. Morgenstern urged the use of pragmatic and cost-effective ways to
implement interventions, such as educating at-risk populations of the signs of stoke and of when
to call 911. He also urged people to think globally and to act locally to reduce stroke disparities by,
among other things, participating in research and advocacy as well as in stroke prevention and
preparedness education for underserved populations.
Valery Feigin, MD, PhD, AUT University, Auckland, New Zealand, expanded on
Dr. Morgenstern’s presentation, discussing mechanisms in which to reduce the global burden of
stroke through prevention. Citing data from the INTERSTROKE study [O’Donnell MJ et al. Lancet
2010], he highlighted that >90% of strokes are caused by modifiable risk factors and are therefore
preventable (Figure 1).
Figure 1. Risk Factors for Ischemic Stroke and Intracerebral Hemorrhagic Stroke
BP >160/90
52%
Peer-Reviewed
Highlights From
• Self-reported diabetes
mellitus (5%)
• Excessive alcohol intake
(>30 drinks/month; 4%)
Physical
inactivity
29%
Abdominal
obesity
27%
• Psychosocial stress (5%)
• Apolipoproteins (high
ApoB to ApoA ratio; 25%)
• Cardiac causes (espeically
atrial fibrillation for
ischemic stroke; 7%)
Poor diet
19%
Current smoking
19%
>80% Risk of stroke
+
>90% Risk of stroke
AF=atrial fibrillation; ApoA1=apolipoprotein A1; ApoB=apolipoprotein B; BP=blood pressure; DM=diabetes mellitus.
Reproduced with permission from V Feignin, MD, PhD.
Official Peer-Reviewed Highlights from International Stroke Conference 2013
11
http://www.strokeconference.org
Table of Contents for the Digital Edition of MD Conference Express ISC 2013
MD Conference Express ISC 2013
Contents
Defending the Stroke Guidelines
Stroke Update: An Overview of What Is Going on in the Area of Stroke
Brain Imaging Does Not Help Identify Patients Who May Benefit From Endovascular Treatments for Acute Ischemic Stroke
MISTIE II Trial: 365-Day Results Demonstrate Improved Outcomes and Cost Benefit
Addition of AMPLATZER PFO Occluder to Medical Therapy Is Beneficial in Patients With Cryptogenic Stroke and PFO
Intraoperative CT-Guided Endoscopic Surgery for ICH [ICES]
The EMBRACE Trial: Prolonged Ambulatory Cardiac Monitoring Improves the Detection and Treatment of Atrial Fibrillation in Patients With Cryptogenic Stroke
DP-b99 Does Not Improve Recovery Following Acute Ischemic Stroke
The Secondary Prevention of Small Subcortical Strokes Trial: Blood Pressure Intervention Results
Final Results of the Solitaire FR Thrombectomy for Acute Revascularization: The STAR Trial
Clopidogrel Plus Aspirin Reduces Risk of Recurrent Stroke: The CHANCE Trial
Reversal of Chronic Hypoperfusion to Improve Cognitive Function: The RECON Trial
Cardioembolic Stroke
IMS III
Novel Anticoagulants in Vascular Neurology Practice
Wake-Up Stroke
Virtual Reality in Stroke Rehabilitation
Reward Improves Long-Term Retention of a Motor Memory Through Induction of Offline Memory Gains
MD Conference Express ISC 2013
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