Basis for primary prevention of stroke under a Social Health Act

The probability of reducing the prevalence of stroke by control of risk factors has been calculated to be as high as 80%, particularly among patients with auricular fibrillation, based on randomized therapeutic trials. Because of the lack of education about stroke risk factor reduction among community physicians in Austria, the reduction of stroke prevalence has failed to reach such potential benefit. To achieve a basis for primary prevention of stroke identification of those at low, medium, and high vascular risk has been recommended. The present study has undertaken such goals by quantifying prevalence of vascular risk factors, as well as therapeutic interventions among the population of Graz, Austria, within the framework of our present socialized health system. Persons between the ages of 50 and 70 years comprise our cohort of 2,120 volunteers that have been randomized by our registry in Graz. All selected volunteers underwent stroke probability grading, including identification of potential of risk factors to be controlled or treated. By using 35 items in the screening protocol for risk factors for stroke, probability of stroke risk was evaluated. Minimal vascular risk was present in 686 volunteers; 595 were classified as mild vascular risk, 542 had medium risk, 326 were at high risk, and 71 were at maximum risk. Out of 1434 volunteers with increased vascular risk, 55% have not attempted lifestyle changes or any risk factor treatment. Of these, 30% with maximum vascular risk remain untreated. Existing risk factors have been controlled in 22% and remain untreated in 78%. Therefore, primary stroke prevention must be based on direct contact with volunteers in the age groups in which stroke onset is likely to occur and identifying and treating individuals with the highest stroke probability index.