Stroke prevention in 2001
In the year 2001, we are fortunate to have a substantial appreciation of the complexity and heterogeneity of cerebrovascular disorders. While the complex nature of these disorders precludes a single panacea for prevention of stroke, a number of options are available to benefit our patients. The story to date has been one of partial success. Preventative therapies, in particular the treatment of hypertension, have been credited with a decline in stroke mortality rates of approximately 5% per year between the years 1972 and 1990 (National Institutes of Health, 1996), however this success is limited. The population is aging in the industrialized world and increasing age is a potent risk factor for stroke. For example, life expectancy for Americans has risen from 49 years in 1900 to 77 years in 1997. Consequently, major challenges for further improvements in treatments to prevent stroke remain. The American Heart Association estimated that in 1997, 500,000 new strokes occurred in the United States, another 100,000 recurred, and 160,000 strokes were fatal (Sacco et al., 1997; American Heart Association, 1997). It also estimates that about 4.4 million stroke survivors are alive in the United States in 2000. Worldwide there were 4.4 million deaths in 1997 (Murray and Lopez, 1997) and many more stroke survivors who were disabled. There are regional differences worldwide and major differences in race and gender within regions. Everyone has to die of something, but one hopes not prematurely, or after several years of disability from a stroke.