Abstract
Stroke is a preventable disease. Primary prevention of stroke is often discussed in many forums; however, as neurologists and stroke physicians we are seldom at the forefront where political decisions are made. At the World Stroke Congress in Vienna 2008, Ruth Bonita (1) stated that population-based prevention is the most affordable. A large proportion of potential strokes will be reduced due to tobacco control, salt reduction, nutrition education and a reasonable level of physical activity. For high-risk individuals, pharmacological intervention further reduces stroke occurrence (2, 3).
Prevention of stroke is closely related to the prevention of cardiovascular disease. A close collaboration between cardiologists and stroke physicians may strengthen the impact on politicians and health providers.
The European guideline on cardiovascular disease prevention 2007 update is available at www.escardio.org and also as a pocket guideline.
On an individual level, these guidelines (4) provide risk charts, Systematic Coronary Risk Evaluation (SCORE), predicting the 10-year risk of fatal cardiovascular disease including stroke deaths in the 40–65-year age group at given levels of blood pressure and cholesterol in women and men, smokers and nonsmokers. At www.heartscore.org the individual risk can be calculated for subjects still free of cardiovascular disease. The SCORE risk charts also include a relative risk chart for people < 40 years at a low risk.
Recommendations are given for a healthy lifestyle. Drug treatment is considered if the SCORE risk exceeds 5% per 10 years.
The guidelines were developed by the European Society of Cardiology in collaboration with the European Stroke Initiative, now the European Stroke Organisation; the European Association for Cardiovascular Prevention & Rehabilitation; the European Society of Hypertension; the International Society of Behavioural Medicine; the European Heart Network; the European Association for the Study of Diabetes; the European Atherosclerosis Society; the International Diabetes Federation Europe; and the European Society of General Practice/Family Medicine/WONCA.