Stroke: the global burden

Stroke is a major global health problem. It is a major cause of mortality, morbidity and disability in developed and increasingly in less developed countries. Worldwide, it is the leading cause of healthy years lost in late adulthood, and evidence indicates that the burden of stroke, particularly in terms of morbidity and disability, will almost certainly increase in the foreseeable future. This review aims to generate a better understanding of the present and projected future global burden of stroke, with particular emphasis on the non-established market economy countries (NEMEC). The first part summarizes and interprets the currently available evidence on stroke mortality, incidence, case-fatality and related disability rates from both established and non-established market economy countries. The second part reviews the main risk factors for stroke. For the modifiable factors, it examines current prevalence rates in NEMEC with a view towards identifying patterns that are relevant for predicting future rates of the disease. Reversing the consequences of stroke is difficult, thus primary prevention is of utmost importance. The potential for prevention is illustrated by the experience of Japan, which in the last two decades has seen substantial declines in stroke mortality--mostly due to reductions in dietary salt intake. The last section discusses potential strategies and approaches to effective stroke prevention and highlights other areas that need to be addressed if stroke management in the coming decades is to be effective.