LAUSR

Stroke, as a devastating disease of huge and increasing medical and socio-economic significance, can be called a disease of the 21st century. Almost unheard of as a public health problem before the 19th century and the first three quarters of the 20th century, it is now the second leading cause of death and disability worldwide. From 2005 onwards (Figure 1), stroke prevalence has been increasing exponentially and we now have over 104 million people in the world living with stroke aftermath. The resulting disability-adjusted life-years lost have already reached 132 million, which is more than that from lung, breast, cervical, colon/rectum, stomach, and liver cancers combined. If the current trend continues, by 2030 we will have over 154 million stroke survivors and almost 10 million people dying from stroke every year. Moreover, with over 60% of stroke burden occurring in people younger than 70 years, stroke is no longer a disease of the elderly, and we are witnessing an ominous trend towards increasing stroke incidence and mortality rates in young adults and children in many countries. This clearly indicates that the currently used primary stroke prevention strategies are either not sufficiently effective or not used widely enough, or both. Of particular concern is the shift of public health efforts from implementation of proven effective populationwide preventative strategies to high absolute cardiovascular disease (CVD) risk strategies observed in several high-income countries. It was estimated that those high CVD strategies can at best only reduce the CVD incidence by about 11%, while there is overwhelming evidence from large randomized clinical trials and meta-analyses that just screening of the population for high absolute CVD risk, even when associated with some counseling, is not effective. There is also evidence of the low value of routinely available stroke prevention educational materials, such as books, brochures, leaflets, and websites. It is imperative that primary stroke prevention should be based on both population-wide and individual preventative strategies, with priority given to the reduction of exposure to CVD risk factors for the whole population across the life course. The focus of preventative interventions should be on the reduction of blood pressure level in the whole population, control of elevated blood pressure on the individual level, as well as improving behavioral and lifestyle risk factors profile on both individual and population levels, including reduction of exposure to tobacco use, unhealthy diet (excessive salt and sugar intake, lack of fruits and vegetables), physical inactivity, and the harmful use of alcohol. To be effective, primary stroke prevention strategies at the individual level should be provided for all people at risk regardless of the level of stroke or CVD risk; it needs to be motivational, engaging (interactive), simple to use and understand, widely available across the globe, free of charge, specific for the individual concerned, and based on valid (ideally, culturally specific) information (including internationally recognized guidelines on primary stroke and CVD prevention). To date, the only tool that meets all these requirements is the validated Stroke Riskometer app developed and owned by the Auckland University of Technology (New Zealand), translated into 15 languages (>90% of the world population) and endorsed by the World Stroke Organization, World Federation of Neurology, World Heart Federation, and European Stroke Organisation. Widely recognized as a new paradigm in primary stroke prevention (so-called ‘‘motivational population-wide stroke prevention strategy’’), the app can be downloaded for free to a smartphone, iPad, or Android tablet from Apple Store or Google Play. Figure 1. Age-standardized stroke prevalence per 100,000 people.