Primary and secondary prevention of stroke
Worldwide, stroke is the second leading cause of death (World Health Organization 1997). Approximately two-thirds of stroke deaths occur in developing countries and one third in developed countries. Although stroke is a leading cause of morbidity and mortality among adults, it is well suited for prevention as it has a high prevalence, burden of illness and economic cost, and effective prevention measures (Gorelick, 1994, 1995, 1997; Gorelick et al., 1999). Recent surveys suggest, however, that there is a lack of awareness of stroke warning signs and risk factors by the public (Pancioli et al., 1998) and underutilization or possible misapplication of stroke preventatives by physicians (Goldstein et al., 1996; Brass et al., 1997). We face a challenge to educate the public and physicians in a timely manner about preventive guideline updates, as implementation of clinical preventative services typically remains far behind dissemination of this information (Kottke et al., 1993, 1997). Physicians are trained to care for the sick and may be less familiar with prevention measures for the community at large (Ferguson, 1999; Goldstein, 1999). Both physician and community behavior require modification to enact successful stroke prevention in a population. We have witnessed interest in healthy living and preventive services during the past decades as prosperity has risen (Rose, 1994). In this chapter we will review methodology and results of major primary and secondary stroke prevention programs.