Stroke deaths in England have halved in the last 10 years thanks to better treatment, the research suggests.
The number of strokes has decreased among older people, who have been subjected to medical interventions to control blood pressure, such as statin prescribing. But those under the age of 55 are having more stroke, probably due to obesity and type 2 diabetes.
One of the authors of the work, Olena Seminog, from the Nuffield department of population health at Oxford University, said that reducing deaths was good but preventing strokes would have been even better.
"This is good news, but we should still appreciate the importance of prevention because people who have a stroke have a high chance of surviving now, but many survivors will continue to have [a lot] disability," he said. . "This can sometimes be serious. It will have an impact on their lives and the lives of their families."
The study, published in the British Medical Journal, shows that the total number of strokes decreased by 20% between 2001 and 2010. After adjusting for age and other potential factors, stroke deaths decreased by 55% during the study period.
Most strokes are in older people, often in the 80s, which is where most prevention efforts have been. Of 425,000 strokes in the first decade of the 21st century, about 33,000 were in people under the age of 55.
The increase was observed in the 35-54 age group, with no changes observed in the younger ones. "Much of this increase is due to the increase in rates of obesity and type 2 diabetes," said Seminog. "It is a worrying situation. It shows how obesity affects important conditions such as stroke." The obesity is linked to the increase in blood pressure.
In that age group there were high levels of alcohol and drug use, which increase people's risk. Smoking doubles the risk of stroke, but rates are falling. Salt consumption, which increases blood pressure, has also decreased, although experts say it must be even lower.
Older people tend to have blood pressure monitored by their primary care physician and will be advised to take medications to reduce them and statins to reduce cholesterol deposits that can clog arteries.
Data come from hospital and mortality records for all residents of England aged 20 and older who were hospitalized for stroke or died from stroke between 2001 and 2010. They included both types of stroke – those caused by clots that obstruct blood flow to the brain and also bleed into the brain.
The team based its findings on 947,497 stroke events in 795,869 people, including 337,085 stroke deaths. The average age onset of stroke was 72 years for men and 76 years for women, and the average age of those who died of stroke was 79 for men and 83 for women.
Most of the decline – 78% in men and 66% in women – occurred because better treatment meant that people did not die. There have been campaigns to make people aware of stroke symptoms so as to get medical attention quickly and, where appropriate, anti-clotting drugs.
The remaining 22% in men and 34% in women was due to a reduction in stroke event rates, which decreased overall by 20%.
The authors pointed out that the NHS spent about 5% of its budget on treating people with stroke. "By focusing on prevention and reducing the onset of stroke, key resources can be preserved," they said.
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