Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization

Brainin, Michael; Feigin, Valery; Bath, Philip M; Collantes, Epifania; Martins, Sheila; Pandian, Jeyaraj; Sacco, Ralph; Teuschl, Yvonne

Abstract

The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs).

 This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy.

 (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia.

 (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs.

 (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point.

Citation

Brainin, M., Feigin, V., Bath, P. M., Collantes, E., Martins, S., Pandian, J., …Teuschl, Y. (2019). Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. International Journal of Stroke, 14(8), 818-825. https://doi.org/10.1177/1747493019873706

• Journal Article Type: Article
• Acceptance Date: Jun 13, 2019
• Online Publication Date: Sep 9, 2019
• Publication Date: Sep 9, 2019
• Deposit Date: Sep 12, 2019
• Publicly Available Date: Sep 12, 2019
• Journal: International Journal of Stroke
• Print ISSN: 1747-4930
• Electronic ISSN: 1747-4949
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 8
• Pages: 818-825
• DOI: https://doi.org/10.1177/1747493019873706
• Keywords: Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/2607926
• Publisher URL: https://journals.sagepub.com/doi/10.1177/1747493019873706