Stroke
May 2007
The burden of stroke
- Each year 16 million people experience a stroke and 5·7 million die.1
- 87% of global stroke mortality occurs in low- and middle-income countries.1
- Unless there are population-wide interventions, by 2030 there will be 23 million strokes and 7·8 million deaths each year.1
- Over the next two decades stroke mortality will triple in Latin America, the Middle East, and sub-Saharan Africa.2
- Globally, stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause in people aged 15 to 59 years old.3
- Stroke is the third most common cause of death in developed countries, behind coronary heart disease (CHD) and cancer.3
- Stroke is uncommon in people under 40 years.3
- In many developed countries the incidence of stroke is declining but the actual number is increasing because of ageing populations.3
What is a stroke?
- Ischemic stroke occurs when vessels carrying blood to brain become blocked and oxygen and nutrients cannot get to the brain.4 This accounts for 85% of all strokes.
- Hemorrhagic stroke occurs when blood vessels in the brain burst causing blood leaks in or around the brain.4 This accounts for 15% of all strokes.
Stroke risk factors
- After the age of 55, a person’s chance of having a stroke more than doubles for each decade of life.5
- The risk of stroke increases if there is a family history of stroke, especially if a first-degree relative has had a stroke.5
- Ethnicity is a stroke risk factor: people of Afro Caribbean origin have a much higher risk of death from a stroke than do people of white, European origin.5
- Stroke is generally more common in men than in women but more women who have stroke die than men,5 because they are significantly older than men when they experience a stroke and in poorer health.6
- High blood pressure causes about 50% of ischemic strokes and also increases the risk of hemorrhagic stroke.7
- Having already had a stroke, a mini-stroke known as a transient ischemic attack (TIA), or heart attack, increases the risk of stroke.5
- Having experienced one or more TIAs makes a person 10 times more likely to have a stroke than someone of the same age and sex who has not.5
- Tobacco use doubles the risk of ischemic stroke and quadruples the risk of hemorrhagic stroke.8
- The use of oral contraceptives combined with tobacco use greatly increases stroke risk.5
- Strokes happen twice as often in people with diabetes and hypertension compared to people with hypertension alone.9
- People with diabetes can have up to six times greater a risk of stroke than people without diabetes.8
- Sickle cell disease, an inherited disorder, is the most significant risk factor for stroke in young people.5
- Unhealthy diets that are high in saturated fat, trans fat and salt increase the risk of stroke.5
1 Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurology 2007; 6: 182-187.
2 Connor MD, Walker R, Modi G, Warlow CP. Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurol. 2007;6(3):269-78.
3 J Mackay, G Mensah, Atlas of Heart Disease and Stroke. World Health Organization. Geneva, 2004.
4 Stroke Association. What are the types of stroke? http://www.strokeassociation.org/presenter.jhtml?identifier=1014
5 Stroke Association. Stroke Risk Factors. http://www.strokeassociation.org/presenter.jhtml?identifier=4716
6 Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, Giroud M, Rudd A, Ghetti A, Inzitari D; European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003 May;34(5):1114-9
7 High Blood Pressure. The Merck Manuals Online Medical Library: Home Edition for Patients and Carers. 2003. http://www.merck.com/mmhe/sec03/ch022/ch022a.html
8 American Heart Association/American Stroke Association Stroke Council; Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; Quality of Care and Outcomes Research Interdisciplinary Working Group; American Academy of Neurology. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Jun;37(6):1583-633
9 International Diabetes Federation. Diabetes and CVD Disease: A Time to Act. 2001. IDF. Brussels