The population approach to stroke prevention: a Canadian perspective

To contrast the population and clinical approaches to stroke prevention and to review Canadian data relevant to estimating disease burden, assessing risk factors, designing preventive strategies and organizing health services.

A narrative review of the published literature and statistical data accessible through the Internet.

Unlike the clinical approach, which emphasizes individual patients at high risk diagnosed and treated intensively, usually by medical or surgical means (or both), a population approach focuses on the entire population and bases interventions on behavioural and environmental changes. Stroke offers a particularly promising target for prevention. It represents a leading cause of serious disability, death and reduced quality of life. The aging of our population threatens to increase the already considerable burden. Stroke shares several risk factors with other chronic diseases, especially ischemic heart disease. These risk factors vary in their impact on Canadians (population attributable risk proportion), which is a function of their prevalence and strength of association with the occurrence of stroke. Although effective preventive measures are available for people at high risk, they are not being applied systematically among potential beneficiaries. Small reductions in the exposure to risk factors in the entire population offer an alternative, where even modest success may translate into major gain.

The clinical and population approaches to stroke prevention are complementary. Existing national strategies directed at promotion of healthy life-styles (especially physical activity) and hypertension control, when fully implemented, will reduce the frequency, severity and impact of stroke on Canadian society.