May is National Stroke Awareness Month in the United States, a time to raise awareness about the symptoms, risk factors, and devastating effects of stroke. With stroke being a leading cause of death and disability in the country, it’s crucial to understand the gravity of this condition and the importance of preventive measures. This month also presents an opportunity to celebrate the remarkable progress made in stroke research and treatment while acknowledging the work that still needs to be done to improve outcomes and health equity.

The Staggering Impact of Stroke

The statistics surrounding stroke are truly alarming. According to the American Heart Association’s (AHA) 2024 Heart Disease and Stroke Statistics Update, stroke accounted for approximately 1 in every 21 deaths in the United States in 2021[2]. Even more concerning, on average, someone died of stroke every 3 minutes and 14 seconds in the country that year[2].

In 2021 alone, stroke caused a staggering 162,890 deaths in the United States. Worldwide, the toll was even higher, with 7.44 million deaths attributable to stroke[2]. The update further reveals that between 2011 and 2021, the age-adjusted US stroke death rate as an underlying cause of death increased by 8.4%, and the actual number of stroke deaths increased by a startling 26.3% during the same period[2].

These sobering statistics underscore the urgent need for more effective stroke prevention strategies and improved access to timely and quality stroke care.

Stroke: A Global Health Crisis

Stroke is not just a problem confined to the United States; it’s a global health crisis. The 2024 Statistics Update highlights the devastating impact of stroke worldwide[2]:

• Oceania and Southeast and Central Asia had the highest rates of overall stroke mortality.
• Central Asia and Eastern Europe had the highest mortality rates attributable to ischemic stroke.
• Intracerebral hemorrhage mortality was highest in Oceania, followed by Southeast Asia and central and eastern sub-Saharan Africa.
• Mortality attributable to subarachnoid hemorrhage was highest in Oceania, followed by Andean Latin America, and Southeast and Central Asia.

These regional variations underscore the need for tailored stroke prevention and treatment strategies that address the unique risk factors and healthcare challenges faced by different populations worldwide.

Advances in Stroke Treatment

Despite the grim statistics, there have been significant advances in the treatment of stroke, particularly in the field of acute ischemic stroke management. The biggest recent breakthroughs have been in the acute treatment of ischemic stroke, where restoration of brain blood flow (reperfusion therapy) during the critical window immediately following the onset of stroke symptoms can prevent brain injury[1].

The 2024 Statistics Update highlights the success of endovascular therapies, which involve removing stroke-causing clots using special catheters inserted into the brain’s arteries. Recent international clinical trials have shown that this approach can effectively prevent large strokes, building on previous evidence and guidelines for clot-dissolving medication administered intravenously[1][2].

Additionally, researchers are exploring novel approaches to stroke recovery and rehabilitation. Brain and nerve stimulation therapies are being tested to help patients regain mobility, even months after having a stroke. The Brain Research Through Advancing Innovative Neurotechnologies® (BRAIN) Initiative has adapted epidural spinal cord stimulation to restore arm and hand movement in stroke patients, showcasing the promising potential of such interventions[1].

The Quest for Neuroprotective Drugs

While reperfusion therapies have revolutionized acute stroke care, researchers are also working tirelessly to develop new drugs that can protect brain tissue and improve long-term outcomes after ischemic stroke. The Stroke Preclinical Assessment Network (SPAN), the largest preclinical network in stroke research, is rigorously evaluating candidate drugs that might enhance the benefits of early reperfusion therapy in humans[1].

One particularly exciting development is the upcoming launch of a multicenter clinical study by the NIH StrokeNet network. This study will test the safety and efficacy of a novel investigational biologic agent, developed with NINDS support, that can be administered in conjunction with reperfusion therapies to reduce disability in subjects with moderate to severe acute ischemic stroke[1][2]. If successful, this could be the first drug to treat acute stroke since 2003, representing a significant breakthrough in stroke care.

The Roadmap to Stroke Prevention

While advances in treatment are crucial, the most effective approach to combating stroke is prevention. The AHA’s 2024 Statistics Update emphasizes the importance of addressing and controlling risk factors for stroke, such as high blood pressure, diabetes, obesity, physical inactivity, and smoking.

High blood pressure, or hypertension, is a leading cause and controllable risk factor for stroke. The update reveals that 122.4 million (46.7%) US adults had hypertension between 2017 and 2020, and in 2021, there were 124,508 US deaths primarily attributable to high blood pressure[1][2][3].

Initiatives like the NINDS’s Mind Your Risks® public health campaign are crucial in raising awareness about the importance of controlling high blood pressure, especially among high-risk populations like Black men in their late 20s to mid-40s. By encouraging lifestyle changes and regular blood pressure monitoring, campaigns like these can play a vital role in reducing the risk of stroke and associated conditions like dementia[5][6].

Another significant risk factor for stroke is diabetes. According to the 2024 Statistics Update, in 2021, 103,294 US deaths were attributed to diabetes, and globally, an estimated 1.70 million deaths were attributed to the condition[2][3]. Addressing the diabetes epidemic through lifestyle modifications and proper management is essential for stroke prevention.

The Importance of Health Equity

While stroke can affect anyone, certain populations are disproportionately impacted by this condition due to socioeconomic, environmental, and genetic factors. The 2024 Statistics Update highlights the striking disparities in cardiovascular disease (CVD) prevalence, with 59.0% of non-Hispanic Black females and 58.9% of non-Hispanic Black males having some form of CVD between 2017 and 2020 – the highest prevalence of any race category[2][3].

Longitudinal, population-based studies like the Northern Manhattan Study (NOMAS) and Reasons for Geographic and Racial Differences in Stroke (REGARDS) have provided valuable insights into stroke risk factors and disparities. These studies have underscored the importance of tailoring stroke prevention strategies based on factors like sex, race, and age, rather than adopting a one-size-fits-all approach.

Addressing health disparities and ensuring equitable access to stroke care, from the emergency setting to inpatient hospital care, is a top priority for organizations like the NINDS and the Brain Attack Coalition. Collaborative efforts and strategic planning are underway to tackle these disparities and improve stroke outcomes for all populations.

The Road Ahead

As we observe American Stroke Month 2024, it’s important to recognize the progress made in stroke research and care while acknowledging the challenges that lie ahead. With stroke being largely preventable through lifelong control of risk factors, raising awareness about these risk factors and promoting healthy lifestyle choices is paramount.

Organizations like the American Heart Association and the National Institutes of Health (NIH) play a crucial role in funding research, disseminating information, and driving public health initiatives aimed at stroke prevention and improved outcomes. The AHA alone has funded more than $5 billion in research since 1949, solidifying its position as the largest non-profit, non-governmental funder of cardiovascular and cerebrovascular research in the United States[2].

However, the battle against stroke requires a concerted effort from all stakeholders, including healthcare professionals, policymakers, researchers, and the general public. By promoting stroke awareness, advocating for equitable access to care, and supporting ongoing research efforts, we can work towards a future where the devastating impact of stroke is minimized, and more lives are saved.

In conclusion, American Stroke Month 2024 serves as a powerful reminder of the immense toll stroke takes on individuals, families, and communities worldwide. However, it also highlights the remarkable progress made in stroke prevention, treatment, and rehabilitation, offering hope for a future where stroke is no longer a leading cause of death and disability. By working together and prioritizing stroke awareness, prevention, and equity, we can make significant strides in reducing the burden of this devastating condition.

References:

[1] “May Is Stroke Awareness Month.” National Institute of Neurological Disorders and Stroke, 19 May 2023, https://www.ninds.nih.gov/news-events/directors-messages/all-directors-messages/may-stroke-awareness-month-2023.

[2] American Heart Association. 2024 Heart Disease and Stroke Statistics: At-a-Glance. 2024, https://www.heart.org/-/media/PHD-Files-2/Science-News/2/2024-Heart-and-Stroke-Stat-Update/2024-Statistics-At-A-Glance-final_2024.pdf.

[3] FastStats – Cerebrovascular Disease or Stroke. 2024, https://www.cdc.gov/nchs/fastats/stroke.htm.

[4] Felling, Ryan J et al. “Roadmap for the Assessment and Management of Outcomes in Pediatric Stroke.” Pediatric neurology vol. 141 (2023): 93-100.doi:10.1016/j.pediatrneurol.2023.01.008

[5] “7 Things You Can Do to Prevent a Stroke – Harvard Health.” Harvard Health, Harvard Health, 14 May 2013, https://www.health.harvard.edu/womens-health/8-things-you-can-do-to-prevent-a-stroke.

[6] “5 Critical Steps to Help Prevent a Stroke.” https://www.heart.org, 5 May 2021, https://www.heart.org/en/news/2021/05/05/5-critical-steps-to-help-prevent-a-stroke.