Evidence of a fall in the incidence and severity of stroke

In Oxfordshire,England, for the first time anywhere in the world, there is reliable evidence of a fall in the incidence and severity of stroke in recent years, Oxford University researchers reported in The Lancet this week.

By performing a detailed study of all aspects of stroke in Oxfordshire during 2002-2004, Dr Peter Rothwell and his colleagues in Oxford's Department of Clinical Neurology have been able to compare incidence and severity of stroke with that in a similar study performed in Oxford in the early 1980s. They have shown that stroke incidence and severity have fallen substantially.

The fall is despite a major increase in the age of the population: 33 per cent more people are aged over 75 now than in the early 1980s. Given the rapidly ageing population in the UK, the expectation has been that the burden of stroke, which tends to occur in late middle age and in the elderly, will increase dramatically – what the World Health Organisation has called a 'looming epidemic'. These results offer a more optimistic outlook.

The study also showed that the change in stroke incidence has been associated with major increases in the prescribing of preventive medication by GPs, and substantial improvements in the control of risk factors. There has been uncertainty about the extent to which blood pressure lowering, cholesterol lowering, and antiplatelet drugs, which have been shown to prevent stroke in clinical trials, can reduce the burden of stroke in the general population, but this study suggests that their impact has been considerable.

Dr Rothwell said: 'Although we cannot prove conclusively that the 40 per cent reduction in the incidence of disabling or fatal stroke is a direct result of the measured increase in use of preventive medication, we know from clinical trials that the observed changes in medication and risk factors will have had a substantial effect. The importance of the paper is that it provides the first evidence that we can reduce the incidence of stroke at the community level – despite the ageing population.'

'The study also shows that we are likely to be able to reduce incidence even further by more widespread use of preventive treatment.'

Stroke is already the most expensive single condition for the NHS, the most common cause of adult disability in the developed world, and is projected to become soon the most common cause of death worldwide, ahead of cancer and coronary heart disease.

Dr Rothwell said: 'It is good to see how much can be achieved by relatively simple medical practice in the community. The results are very good news for Oxford medicine, particularly Oxfordshire GPs, who are the people whose work has resulted in the changes that we have seen over the last 20 years.'

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