Vasileios-Arsenios Lioutas, MD
Despite the advances in stroke treatment in its acute phase, the burden mortality and disability toll remain considerable. Given that the risk factors are largely treatable, recognizing and modifying them bears particular significance. What appears to be particularly difficult is convincing patients of the importance of addressing certain conditions; the notion that adhering to a seemingly irrelevant treatment significantly increases the odds of surviving free of harmful complications.
In this interesting population-based epidemiologic study, Drs Yatsuya et al. attempt to delineate the epidemiologic landscape in Japan regarding stroke incidence and associated risk factors, aiming to develop a simple, easy to comprehend point-based prediction model.
Salient findings include the reproduction of other epidemiological studies’ finding regarding the significant risk attributed to hypertension, in comparison to the rest of the traditional vascular risk factors. What is more remarkable is the fact that patients with hypertension, even when treated and with optimal blood pressure have higher stroke incidence compared to those without history of hypertension and blood pressure in the same range. It is difficult to know whether this represents delayed detection and treatment initiation or inadequate long-term blood pressure control. Two significant limitations are the marked absence of atrial fibrillation from the prediction model and the lack of stroke subgroup analysis-at least into hemorrhagic vs ischemic.
Lastly, an important question that needs to be investigated in the future is whether the development of a simple, point-based prediction model will indeed improve the physician-patient communication, increase preventive treatment compliance and reduce the incidence of stroke.