Prevalence and Prevention of Stroke in the United States

Stroke Prevention Prevalence in U.S.

The purpose of this work is to develop a clear picture of the epidemiology of stroke, in the U.S. The rising incidence of stroke and stroke risk behaviors has placed stroke high on the list of priorities, with regard to disease prevention and treatment and costs the nation billions of dollars a year to treat and deal with. Not to mention the human toll that stroke takes on individuals and families. The reduction of stroke events in the U.S. is unlikely to occur, across the board, and may in fact be at risk of increasing as a result of behavioral risk and an overall reduction in the number of people insured in the nation.

Strokes of all types are the third leading cause of death in the U.S. According to the American Heart Association this makes the estimated number of deaths from stroke at about 150,000 people annually. Per 100,000 people in 2004 50 people in the general population died of stroke, among black men the same statistic rises to 74.9, black women 65.5, for white men 48.1 and the lowest statistic for white women 47.2. The statistical data for states indicate that in 2004 South Carolina (65.2), Alabama (65.0) Arkansas (65.0), Tennessee (64.7) and North Carolina (61.1) had the highest per capita rate of death per 100,000. Yet, these numbers pale in comparison to how frequently strokes occur, as almost 780,000 stroke events are recorded in the U.S. annually. Of these 600,000 are first strokes for those who experience them and nearly 180,000 are having a recurrence of stroke. In addition to being the third leading cause of death strokes are the leading cause of long-term disability, a statistic that has remained relatively constant from before and after the turn of the century. Community wide social economic cost of stroke, in 2008, is estimated to be about 65.5 billion dollars. (CDC, 2008, NP)

International statistics are even less favorable, as prevalence is greater in developing and poor nations and is increasing significantly with each year. The youth obesity trend is also a trend occurring internationally.

Cardiovascular disease now ranks as the leading cause of death, resulting in one third of all deaths globally. The Atlas of Heart Disease and Stroke, published by the World Health Organization (WHO) in conjunction with the United States Centers for Disease Control and Prevention (CDC), was launched on 26 September 2004 to coincide with the fifth annual World Heart Day, a major driving force for encouraging heart disease and stroke prevention worldwide. The report shows that heart disease and stroke are also becoming more deadly, with a projected combined death toll of 24 million by 2030. Both kill 17 million persons every year and are increasingly likely to afflict those in poor countries, WHO said.Young people are increasingly adopting unhealthy lifestyles. Obesity, poor diets, smoking and physical inactivity -- the leading causes of heart disease and stroke -- are now being seen at an alarmingly early age. With children, adolescents and heart disease being the focus of the 2004 World Heart Day, WHO said that the young should be encouraged as early as possible to lead a healthy lifestyle, including diet and exercise, before they can develop any serious problems. (Reinhardt, 2005, p. 46)

It is also noteworthy that these locations are much less likely to provide adequate medical/emergent and routine care for chronic high blood pressure and other risk factors for stroke and heart disease.

Though stroke prevention programs exist in the majority of states, many funded in part by the CDC, prevention is not a major universal development in the U.S., despite the cost and the human toll of strokes. (CDC, 2008, NP) Some medical prevention methods, such as general medical treatment for high blood pressure has had significant results in reducing second or even third stroke events in people, yet this is old material and many of these strides have been overshadowed by increasing rates of heart disease, obesity and high cholesterol. ("Better Control of Hypertension," 1987, p. 2) ("Health; Blood Pressure Drugs," 2008, p. NA) Yet, primary strokes are not prevented at nearly the same level, as known risks are often chronic diseases and/or conditions that go unrecognized, untreated or when diagnosed are not resolved to any serious degree. Additionally, there are many environmental risk factors (Ha, Lee & and Jr., 2007, p. 1204) and behavioral risk factors that are on the rise, rather than the decline, such as the growing obesity epidemic indicative of limited physical activity and poor diet, especially among children, and smoking and alcohol use among both adults and children. (Mukamal, 2006, p. 199) (Wang, Chen, Chung, Poon, Lew & Tam, 2007, p. 583) Intervention points are associated with increased awareness of preventable risk factors, including but not limited to physical activity, age, hypertension, other underlying coronary disease, diabetes, smoking and drinking as well as emphasis on the need to change these habits or conditions through behavioral or medical means. Medical interventions in general seem to be more enforceable and elicit more compliance that behavioral change agents, as it is difficult to get individuals to change without visible and physical reasons to do so, and sometimes even when these reasons are present. Chronic disease management remains an inexact science that is often limitedly treated by a person's general practitioner, when they have one, and is sometimes supported by referral one or a few time visits to a specialist. These situations rarely change to one where specialist treatment is concurrent with GP treatment unless disease has reached a dangerous level, such as after an individual has already had his or her first stroke.

Yet, it must also be made clear that stroke prevention often revolves around, as has been said reducing the negative long-term disabilities associated with the occurrence of stroke, brain damage resulting in partial or complete paralysis (often hemi-paralysis involving one side of the body), aphasia, dysphasia, incontinence, limited swallowing or breathing ability and in some cases persistent coma.

Some of the highest rated risk factors for stroke include: "older age, male gender, black race/ethnicity, family history of stroke, physical inactivity and obesity, cigarette smoking, diabetes, high cholesterol, high blood pressure, atrial fibrillation, peripheral artery disease, or cartoid or other artery disease." (CDC, 2008, NP) as we also know many of these conditions are treatable and preventable but often lead to the major complication of stroke, which is defined as the loss of blood circulation to part or all of the brain for any amount of time. According to the CDC the major rout of prevention programs is not necessarily to try to completely prevent them, all though this would be ideal, but is to teach people what they are, what the signs and symptoms are and when they should seek medical intervention if they suspect stroke is occurring. People are told that "time lost is brain lost" with regard to stroke because damage to the brain spreads as blood supply lessons and possible swelling ensues. The programs are designed to help people see the signs and symptoms not only in themselves but in others and to help when rapid intervention is needed. Prevention then does not necessarily decrease the incidence of stroke but decreases the length of time from onset of symptoms that a person seeks medical care, decreasing the brain damage done by the even and hopefully limiting the long-term effects. Additionally, when individuals receive routine medical care they are much more likely to be treated for high blood pressure, as well as high bad serum cholesterol levels, both through dietary intervention and pharmacological means. When these two issues are treated and controlled some risk of stroke is decreased, even in high risk cases. In fact more routine prescribing of such drugs, even in cases where only moderate hypertension and/or cholesterol are found, has decreased the incidence of stroke, but more commonly second stroke than first stroke. ("Health; Blood Pressure Drugs," 2008, p. NA)

Recommendations for the CDC, AHA and other organizations would be to continue to advocate for prevention of stroke through the current plan, with additional support for behavioral change education, that has been statistically shown to help people alter dangerous behaviors. Advocating for better nutrition, as well as greater physical activity is also greatly needed, for many reasons not limited to stroke prevention. Continuing to raise awareness about signs and symptoms of stroke will also help the public learn to better and more rapidly recognize the occurrence of stroke and adequately deal with it through emergency medical intervention. One last recommendation would be to better inform individuals about TIAs as such events mimic strokes but symptoms often resolve within 24 hours, yet they are a clear and present sign that a stroke may be pending and the person should seek routine medical care to help prevent this occurrence.

Transient ischemic attacks (TIAs) are symptomatically small strokes. Like a major stroke, a TIA occurs when a part of the brain suddenly fails to get an adequate…