Recent advances in stroke management

Life's Simple 7 and the risk of stroke in Finnish men: A prospective cohort study

BACKGROUND

Population-wide preventive measures constitute important approaches towards reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association's (AHA) Life's Simple7 (LS7) score and the risk of stroke in men.

METHODS

The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline (1984-1989). LS7 was computed from AHA's cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: low (0-2), medium (3-4) and high (5-7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke.

RESULTS

During a median follow-up of 26 years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2-6. Men with high LS7 had 48% (HR: 0.52; 95%CI: 0.32-0.86) lower risk of total stroke when compared with those with low LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29-0.87) lower risk among men with high LS7 compared with those with low LS7.

CONCLUSION

LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Finnish population.

Organization of Medical Care in Acute Stroke: Importance of a Good Network

Stroke is a medical emergency which requires hospital care. Therapeutic and effective organizative measures, such as thrombolysis and stroke units, are available, but early attention is required, as the benefits are time dependent (therapeutic window). To achieve this objective, a high level of organization and coordination is required between the various steps of care. The chain of attention in acute stroke (from symptom onset till stroke unit admission) is a complex process. The main points are reviewed: delay in attention, knowledge and attitude towards stroke, emergency transportation, neurological attention, educational campaigns, clinical protocols and pathways, stroke codes, and existing resources for care. The organization must be modified to have the resources for care necessary for attending acute stroke available, if we want to achieve the real objective of maximum benefit for our patients as set out in the Declaration of Helsingborg.