The “One in Six” motto of this year’s World Stroke Day on October 29 is an apt reminder that one in six people will suffer a stroke at some point during their life and that someone dies from a stroke every 6 seconds. The World Stroke Organization (WSO) points out that the victims consist of ordinary people who live everyday lives, however, 85% of these people have risk factors that can prevent a stroke if identified.

Currently over one million strokes occur in Europe each year. Stroke, alongside heart disease, chronic respiratory diseases, cancers and diabetes is a non-communicable disease that increases with unhealthy diets, physical inactivity, cigarette-smoking and excessive alcohol consumption. According to global predictions, mortality numbers caused by fatal stroke along with heart disease and cancers will steadily rise from approximately 6 million in 2010 to nearly 8 million by 2030.

The risks for stroke are the same as for coronary heart disease, highlighted The European Society of Cardiology. Furthermore, atrial fibrillation, the most frequent heart rhythm disorder, has also been clearly linked to higher risks of stroke.

Speaking on behalf of the European Society of Cardiology, Professor Freek Verheugt, from the Onze Lieve Vrouwe Gasthuis in Amsterdam explains:

“Stroke is not an inevitable consequence of ageing, so by identifying and modifying risk factors there are opportunities to reduce the incidence and mortality rate of this devastating condition.”

The WSO has devised six steps for everyone to reduce their risk of stroke:

  1. Learn the warning signs of a stroke
  2. Check your personal risk factors: high blood pressure, high cholesterol levels and diabetes
  3. Exercise regularly and keep physically active
  4. Eat a healthy diet and avoid becoming obese
  5. Avoid cigarette smoke and seek help to stop
  6. Restrict your alcohol consumption.

The WSO also points out that timing is essential if any of the following warning signs appear, such as:

  • Sudden numbness, in particular if it only affects one side of the body,
  • Loss of balance or sudden vertigo,
  • Sudden difficulty in speaking or seeing,
  • and severe headaches with no apparent cause.

Professor Verheugt stresses that any of these signs are a reason for alarm. A stroke is a medical emergency and timing is vital, as it can make an enormous difference in terms chances of survival.

The WSO emphasizes that, “Time lost is brain function lost.” It has also been established that stroke survivors stand a better chance if admitted to dedicated stroke units staffed by multidisciplinary teams, as hospital care, medication, vascular surgery and rehabilitation remain the cornerstones of treatment.

During a stroke, also known as cerebrovascular disease, blood vessels carrying oxygen to the brain are either blocked by a clot (ischemic stroke) or rupture (haemorrhagic stroke), which results in brain cells dying due to oxygen and nutrient deprivation. The severity of a stroke is determined by the extent and location of the damaged brain cells.

The World Health Organization (WHO) defined stroke in 1976 as “a neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours.”

According to the 2007 updated ESC Clinical Practice Guidelines on Cardiovascular Disease Prevention, stroke is listed alongside coronary artery disease, heart failure and peripheral artery disease as a cardiovascular disease that can be prevented. Although the Guidelines differentiate between hemorrhagic stroke, affecting about 15% of cases, and ischemic stroke, they add that the causes of many strokes remain unidentified. They also state, “antihypertensive treatment reduces risk of both ischemic and hemorrhagic stroke”, and that “stroke prevention is still the most important effect of antihypertensive treatment”.

In 2010, the Interstroke study established after evaluating stroke data from 22 countries, that 90% of stroke is linked to ten risk factors, with the highest attributable individual risk factor being 35% due to hypertension, 26.5% due to waist-to-hip ratio and 19% for those who currently smoked.

Furthermore, a study with a 20 year follow up period in which nearly 50,000 people in Finland were assessed in terms of activity levels for reducing stroke revealed that “high physical activity” was linked to lower risks of stroke than low physical activity. The study showed similar risk reductions with “daily active commuting”.

The ESCs declared goals for cardiovascular health throughout the E.U. are defined in the European Heart Health Charter and consist of:

  • Zero diabetes
  • Zero smoking
  • Eating five portions of fruit and vegetables per day
  • A three-kilometer daily walk
  • Blood pressure lower than

Professor Verheugt points out that some patients with irregular heart beats also have a significant risk of stroke, saying:

“All individuals with irregular heart beat should see a doctor, who can diagnose whether this heart rhythm disorder is likely to lead to stroke. If so, blood thinning medication can reduce the risk of stroke by up to 70%.”

Written by Petra Rattue