ESOC 2018: Global Perspectives of Stroke Joint ESO – WSO Session

Chairs: Janika Kõrv, Michael Brainin

The Global Perspectives of Stroke Joint ESO – WSO Session covered important topics related to primary prevention and service organization concentrating mainly on developing world issues.

Dr. Peter Sandercock (UK) started the session with a message that non-communicable diseases (NCDs), including stroke, are major drivers of poverty and of health inequalities, they impose large economic burdens on households. There is a need by National Governments to adopt a global systems approach, with policy informed by WHO, WSO and key  stakeholders, to:  tackle environmental pollution, poverty,  health inequalities, gender inequality, unsustainable cities and deliver  universal health care reform, targeted to the poorest and  most vulnerable populations.

Dr Rufus  Olusola Akinyemi  (Nigeria) presented data about HIV and risk of stroke. He highlighted that HIV infection, treated or not treated with cART, is associated with significant increases in risk, incidence and prevalence of stroke which is predominantly ischemic in nature. The mechanistic link between HIV and stroke was explored, available epidemiologic evidence of the risk of stroke in HIV infection and future research perspectives were summarized.

The high variability of medical management of stroke and distribution of rehabilitation services in Sub-Saharan Africa was highlighted by Dr Alan Bryer from South Africa. Swallowing difficulties and shack housing are independently associated with poor outcome after discharge from hospital following stroke. The Angels initiative which was borne in South Africa has been active in the region with activities that have included establishment of stroke centres with training of emergency medical services, medical, and allied health care workers in stroke care. Risk factor surveillance in densely populated urban areas continues to be undertaken. Remote rural areas in Sub-Saharan Africa remain a challenge for modifying factors that affect functional outcome after stroke.

Dr Bo Norrving (Sweden) showed in his presentation that cutting high consumption of salt is highly likely to reduce risks for stroke, whereas the benefit of aiming for very low salt levels are debated. Recent studies suggest that salt affects the brain also by mechanisms other than blood pressure. Moderating salt intake is likely a good practice to keep the brain healthy.

The burden of disease from stroke continues to be disproportionately borne by developing nations within a Global Stroke Belt, with striking geographic variation in stroke burden, as stressed by Dr Anthony Kim from the  USA. While certain favorable trends in health sector and non-health sector factors are apparent, population growth and aging present ongoing challenges to efforts to address the projected rise in stroke and other non-communicable disease burden in the coming decades.

Finally, in his presentation, Dr Pablo M. Lavados concentered on the  burden of stroke  in Latin America (LATAM) which in terms of incidence, mortality and DALYs in LATAM is comparatively lower than in many regions but could be increasing. This burden is heterogeneous in different regions and countries of LATAM. Eleven risk factors explain more than 90% of the population attributable risk of stroke in LATAM of which three (high blood pressure, central obesity and unhealthy diet) emerge as the main risk factors in this these populations.

The overall message of this session was that collaboration of governments, WSO, and WHO is needed to reduce the global burden of st