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Moving From Ambulances To Fences For Strokes

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With the skyrocketing burden of chronic diseases such as cardiovascular illness, diabetes mellitus and cancer on the health and budgets of Western countries, the focus of public health and hospital programs should shift from the acute management to the prevention of these maladies.

The famous surgeon Denis Burkitt, MD is credited with observing that, "If people are constantly falling off a cliff, you could place ambulances under the cliff or build a fence on the top of the cliff. We are placing all too many ambulances under the cliff." For heart disease the "fence" of identifying and modifying behaviors to prevent the majority of events has been described in research studies (http://www.ncbi.nlm.nih.gov/pubmed/15364185). Even Alzheimer's disease has been found to have preventable factors (http://newsroom.ucla.edu/releases/memory-loss-associated-with-alzheimers-reversed-for-first-time).

Strokes remain a huge cause of suffering, disability, and death and the ability to prevent strokes has been challenging. There are many causes for strokes beyond atherosclerosis and whether lifestyle factors can be identified that reliably prevent stroke has been uncertain. In my lectures and writings, I have indicated that up to 60% of strokes might be preventable ( http://www.mindbodygreen.com/0-17473/why-vitamin-l-is-the-best-way-to-prevent-aging.html).

It is with great interest therefore that data from the Global Burden of Disease Study 2013 (GBD 2013) recently published an analysis on on this very question (http://www.ncbi.nlm.nih.gov/pubmed/27291521). The GBD 2013 Study used date from 188 countries on stroke rates between 1990 and 2013 and sought relations with 17 risk factors (e.g., air pollution and environmental, dietary, physical activity, tobacco smoke, and physiological).

The findings were shocking. Globally, 90% of the stroke burden was attributable to modifiable risk factors including 74% due to behavioural factors (smoking, poor diet, and low physical activity). Clusters of metabolic factors (high blood pressure, high BMI, high fasting plasma glucose, high total cholesterol kidney disease) along with environmental factors (air pollution and lead exposure) were the second and third largest contributors to stroke risk. Globally, 29% of the burden of stroke was attributed to air pollution.

The knowledge provided by the GBD 2013 analysis that more than 90% of the strokes are attributable to modifiable risk factors must lead to increased efforts to implement preventive strategies in schools, homes,hospitals, and workplaces. Air pollution has emerged as a significant contributor for stroke and reducing exposure to air pollution should be one of the main priorities particularly in low and middle income countries. We now how to build the fence around 90% of strokes worldwide using whole foods, smoking cessation, increased activity, weight management, and programs for clean air supplies. With hard work, the sounds of sirens responding to strokes can be replaced with the sounds of families free of the interruption that this devastating disease causes.