Advances in Prevention and Health Services Delivery 2010–2011

Abstract

SStroke mortality has decreased, in large part because of better prevention. There are several new treatment options for patients with atrial fibrillation. Reduction in cancer risk may be an additional benefit of aspirin. Aggressive lowering of blood pressure for secondary stroke prevention might be harmful. Changes in the organization of care enhance utilization of evidence-based therapies. Further reductions in stroke risk and mortality are anticipated. In December 2010, the Centers for Disease Control and Prevention released 2008 data indicating that stroke declined from the third to the fourth leading cause of death in the United States, in part reflecting a steady decline in stroke-related mortality.1 There were similar reductions in Western Europe.2 Arguably, more effective prevention is the greatest contributor to the declines.3 Declining stroke rates with medical therapy suggest that revascularization procedures for most persons with asymptomatic carotid artery stenosis may no longer be of value4 and contributed to negative trials of angioplasty/stenting for intracranial steno-occlusive disease5 and extracranial–intracranial bypass for carotid occlusion.6 New research supports both novel and established therapies, and improved …