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Stroke: Current Screening Has No Significant Effect On Incidence Or Mortality

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EIU Report Shows Lack Of Integrated Follow Up Care Can Increase Risk Of Heart Attack Or Stroke

In a joint statement published in The Lancet, the
two leading NGOs called for governments to move away from
the widely adopted approach of screening individuals at
high-risk of CVD, towards investment in primary prevention
at population level.

This would see governments
prioritise tobacco and alcohol control measures, as well as
the reduction of salt and trans fats in processed foods, and
address sedentary lifestyles.

“When 80 percent of
strokes happen to people who are not categorised as
high-risk, we clearly need to rethink our approach.” says
Professor Valery Feigin, Director of the National Institute
for Stroke and Applied Neurosciences (NISAN) at Auckland
University of Technology
(AUT).

“Labelling people as low-risk
provides false reassurance and reduces their motivation to
control their risk factors, including behaviour risk factors
like poor diet, physical inactivity, smoking and alcohol
use,” he says.

The adult lifetime risk
of stroke is now one-in-four, compared to one-in-six less
than two decades ago.

World Stroke Organisation (WSO)
President, Professor Michael Brainin, says: “Global
progress on prevention has stalled at an enormous cost to
individuals and an increasing cost to society. This failure
has been made more visible by the current global health and
economic crisis, where poor population health and fragile
healthcare systems have combined with COVID-19 to deliver a
perfect storm”.

Professor Feigin, who serves on the
WSO Executive Committee, says there is ‘scant’ robust
scientific evidence that current national screening
programmes offer value for money in terms of reducing the
burden of disease.

“By focusing all of our efforts
on identifying and treating diseases of the circulatory
system, we are missing the opportunity to intervene on their
shared causes much earlier, when the costs are lowest,” he
says.

The estimated benefit-cost ratio would be $10.90
in economic and social returns for every $1.00 spent on
population-wide primary prevention, according to The Lancet
Taskforce on Non-Communicable Diseases
(NCDs).

Professor Feigin says the results would be
evident within a year or two – most certainly within an
election cycle. He maintains that the annual number of new
strokes in New Zealand could be halved, from more than 8,000
to 4,000.

“The benefits of population-wide primary
prevention go beyond stroke and ischaemic heart disease –
there would be positive flow-on effects for a range of NCDs,
including diabetes and most cancers,” he says.

“In
the past 30 years, the number of stroke survivors has
tripled, yet budgets for stroke-related services remain
largely static. The current approach to stroke prevention
and treatment is unsustainable, and governments must take
radical action
now.”

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