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Stroke continues to have an enormous impact on the public health of almost every nation. Ranking among the leading causes of death, stroke is far more often disabling than fatal, and results in enormous costs measured in both health-care dollars and lost productivity. In the United States, almost 150,000 deaths are attributed to stroke, and each year 550,000 Americans experience a stroke (table 1).1 Stroke is the leading cause of serious disability in the United States, with one-quarter to one-half of stroke survivors having complete or partial functional dependence on activity of daily living scales. Annual direct and indirect costs for health care expenditures and lost productivity have been estimated at a staggering $20 to $40 billion.1 Over the next decade, the aging of our population and the changing racial and ethnic composition are likely to increase the public health impact of stroke.
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Table 1 Public health impact of stroke in the United States
Emerging therapies are helping us to reduce the morbidity and mortality after stroke. However, these advances need to be coupled with a greater emphasis on stroke prevention measures. Considerable research has led to a better delineation of stroke risk factors and outcomes, as well as an expanded understanding of pathophysiologic stroke subtypes. Identification of risk factors for initial ischemic stroke, characterizing the determinants of outcome after ischemic stroke, and recognition of the heterogeneity of ischemic stroke subtypes provide the basis for our primary, secondary, and tertiary stroke prevention strategies.
Identification and control of stroke risk factors. The cornerstone of all stroke prevention strategies is to identify subjects who are at increased risk for stroke and to modify the risk if possible(figure). Although some factors are not readily modifiable, others are easily amenable to medical or surgical modification(table 2). Age, gender, family …
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