Public awareness of stroke risk factors in high-income countries: A systematic review

Stroke remains a significant health concern in high-income countries (HICs) and is increasing among younger adults. Although largely preventable, public awareness of stroke risk factors in HICs is not well established. We assessed awareness levels in World Bank-classified HICs and identified associated factors.

Systematic searches used Ovid MEDLINE, PsycINFO, Academic Search Complete, CINAHL, Cochrane Review Library, Emcare, and ASSIA. Two authors independently screened studies and extracted data. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Due to heterogeneity, narrative synthesis was conducted. Exploratory analyses including visual mapping and descriptive cross-country comparisons were performed despite methodological heterogeneity. Protocol registered on PROSPERO (CRD42025621931).

Of 2146 papers screened, 23 met inclusion criteria. Most studies reported low stroke risk factor awareness. Hypertension was most frequently identified, followed by smoking, dyslipidaemia, and diabetes. Sedentary lifestyle, alcohol consumption, ethnicity, and atrial fibrillation were least recognised. Risk of bias assessment revealed sampling and generalisability concerns in most studies. Most reported associations were unadjusted for potential confounders. Higher education was linked to greater awareness. Marked geographical clustering occurred, with 65 % of studies from Middle Eastern countries, predominantly Saudi Arabia.

This review uniquely identifies critical evidence gaps including under-representation of diverse populations, lack of standardised awareness metrics, and predominance of unadjusted analyses in HIC stroke risk factor awareness research.

Stroke risk factor awareness gaps are prevalent and may limit prevention efforts. Large-scale, methodologically robust studies across diverse geographical, socioeconomic, and ethnic populations within HICs are urgently needed, as awareness characteristics may vary dramatically even within high-income settings. Targeted education is necessary for primary prevention strategies.