“This latest report demonstrates that we continue to make significant headway in reducing the risk of first stroke in the general population,” says Eugene L. Scharf, MD, a neurologist at the Mayo Clinic in Rochester, Minnesota, who was not involved with this paper. “Those of us in the stroke community are very excited by this news because it shows us that what we do every day in regard to stroke prevention and treatment matters and, even more important, is having an effect.” Researchers note that the incidence of stroke in people 65 and over has dropped at a rate of 32 percent every 10 years, despite an increase in high blood pressure and type 2 diabetes since 1987. According to the Centers for Disease Control and Prevention, an estimated 33 percent of Americans have hypertension. The number of people diagnosed with type 2 diabetes in the United States increased by 382 percent from 1988 to 2014, according to American Diabetes Association. What seems to counteract that rise is the substantial increased use of antihypertensive and cholesterol-lowering medications, says Dr. Scharf. “If you look in the 1980s and 1990s, the prevalence of people taking antihypertensive medications was around 30 percent. In this most recent cohort, that number has grown to 70 percent of people,” he says. The study began in 1987, what Scharf calls the “prestatins era,” when only 2 percent of the population was on cholesterol-lowering medication. “Compare that to the most recent snapshot of 2011 to 2017, where over half the people are taking statins,” he says.
Two Major Factors Contributing to Stroke Reduction
Hypertension is the single most important modifiable risk factor for stroke, but controlling cholesterol is important as well, says Scharf. “The increased number of people taking those medications probably explains a vast majority of the effect that we’re seeing here,” he says. Another important factor in the reduction of stroke in the last three decades is smoking, says Scharf. “The rates of smoking decreased substantially, and the number of former smokers increased substantially, which means people are quitting smoking,” he says. According to the American Lung Association, the number of adults smoking in the United States has decreased by more than half, from 28.8 percent in 1987 to 14 percent in 2017. These findings suggest that many of the people who are at a higher risk for stroke are seeing their doctor and making efforts to improve their risk factors, says Scharf. “I think it’s a collective pat on the back for people trying to live their best lives,” he says. RELATED: Think You’re Too Young for a Stroke, Think Again
Stroke Prevention: Still Room for Improvement
Though the findings are encouraging, stroke continues to be an important cause of death and a main cause of disability in adults, says lead study author Silvia Koton, PhD, an assistant professor in the department of nursing at the School of Health Professions at Tel Aviv University in Israel. “Prevention of stroke is important, and control of risk factors, like blood pressure levels, cholesterol, diabetes, and obesity, together with smoking cessation, increasing physical activity, and maintaining a healthy diet, are key factors in the ongoing effort to reduce the incidence of stroke and lower rates of disability and death associated with stroke,” says Dr. Koton. The medical community needs to continue working to address the disparities in who is having strokes, says Scharf. “Although women have their first stroke later than men, their lifetime risk for having a stroke is slightly higher. African Americans have a higher risk of stroke as well,” he says. “We need to figure out why these groups are at a higher risk and then fix it,” says Scharf. Because being older is a risk factor for stroke, it’s important to try to adopt healthy-aging techniques, says Scharf. Those habits include eating better, maintaining a healthy weight, being engaged in the community, and staying active, he says. “If there was a pill available that would reduce blood pressure and reduce your risk for diabetes, stroke, heart disease, depression, and dementia, and it was free — you just had to take it every day — I think everybody would take that pill,” says Scharf. “That ‘pill’ is physical activity. We’re just not as active as we need to be as a society; if we could increase that it would make a difference in stroke prevention.”
