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Stroke

In Europe stroke accounts for over one in ten deaths each year and is the second largest cause of death after heart disease. New research, published in the European Heart Journal on 14th August, has found that deaths from cerebrovascular disease are declining overall in Europe but that in some countries the decline is levelling off or increasing. 

The study used data from the World Health Organization (WHO) to examine mortality trends in ischaemic stroke (lack of blood flow to the brain), haemorrhagic stroke (bleeding in the brain) and sub-arachnoid haemorrhage, (bleeding between the brain and its surrounding membrane) in European countries between 1980 and 2016. Data were only available by stroke subtype for 43 countries and most of the countries with missing data were in Eastern Europe and Central Asia.

During the 35 year period studied stroke-related mortality declined across Europe and on average the annual  percentage change for included countries was -2.3% for men and -2.5% for women. However, the decline in stroke-related deaths was more frequent and steeper in Western Europe and less frequent and steep in Eastern Europe. 

The researchers found evidence of a recent plateau in stroke-related mortality in nine countries and an increase in five countries. There was a particularly notable increase in stroke-related deaths over the study period in Bosnia, Uzbekistan and Macedonia. 

Co-author Lucy Wright said: “It is important to look at each type of stroke separately. In the most recent period, there were increases in ischaemic stroke in eight countries among men and nine for women, increases in haemorrhagic stroke in three countries in men and one for women, and increases in sub-arachnoid haemorrhage in five countries for men and eight countries for women.” 

The reasons for the overall decline in stroke–related mortality across Europe and recent plateau or increase in stroke-related mortality in some European countries are not completely understood. 

Commenting on the study in their editorial in the European Heart Journal Chris Gale and Barbara Casadai suggested that the understanding of the causal relationship between blood pressure and vascular events, and the treatment of hypertension at scale has had a substantial influence on the decline in stroke mortality. They also highlighted the decline in the incidence of recurrent stroke as contributing to the decline in stroke-related mortality. The influence of factors such as improved detection and treatment of diabetes and dyslipidaemia (high levels of lipids such as cholesterol in the blood), smoking cessation and changes in diet and levels of exercise in reducing levels of stroke mortality were also considered in the editorial.