The socioeconomic and health effect of stroke and other noncommunicable disorders (NCDs) that share many of the same risk factors with stroke, such as heart attack, dementia, and diabetes mellitus, is huge and increasing. [1][2][3][4] Collectively, NCDs account for 34.5 million deaths (66% of deaths from all causes) 3 and 1344 million disability-adjusted life years lost worldwide in 2010. 2 The burden of NCDs is likely to burgeon given the aging of the world's population and the epidemiological transition currently observed in many low-to middle-income countries (LMICs). 5,6 In addition, there is low awareness in the population about these NCDs and their risk factors, 7-10 particularly in LMICs.11 These factors, coupled with underuse of strategies for primary prevention of stroke/NCDs on an individual level and the lack of accurate data on the prevalence and effect of risk factors in different countries and populations have been implicated in the ever-increasing worldwide burden of the NCDs. [12][13][14][15] Of particular concern is a significant increase in the number of young adults (aged <65 years) affected by stroke, 16 and the increasing epidemic of overweight/obesity 17 and diabetes mellitus worldwide. 18 If these trends continue, the burden of stroke and other major NCDs will increase even faster. The increasing burden of stroke and other major NCDs provide strong support for the notion that the currently used primary prevention strategies for stroke and other major NCDs (business as usual) are not sufficiently effective. The most pertinent solution to this problem is the implementation of new, effective, widely available, and cost-effective prevention and treatment strategies to reduce the incidence and severity distribution of stroke and other major NCDs.
Issues With Population-Wide Prevention StrategiesThe recent INTERSTROKE case-control study, conducted in 22 countries worldwide, provided evidence that, collectively, 10 risk factors accounted for 88.1% (99% confidence interval, 82.3%-92.2%) of the population-attributable risk for all stroke. 19 Because many (but not all) of these risk factors are modifiable, the INTERSTROKE data suggest that interventions that reduce blood pressure, promote physical activity, smoking cessation, and a healthy diet, could substantially reduce the burden of stroke. Although a combination of population-wide and individual high-risk prevention strategies were initially advocated >30 years ago, 20 and have since been repeatedly recommended as the most promising strategies to reduce stroke and NCDs burden, there is still no country in the world where both these prevention strategies have been implemented in full. There are major hurdles to implementing population-wide primary prevention strategies, including the need for policy and legislative changes that are often not supported by major industries (such as salt reduction in processed food, reduction of exposure to cigarette smoking, alcohol, and fast food). In addition, there are significant costs associated with the imple...