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Stroke risk down by 24 percent over two decades

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Fewer Americans are having strokes, and when they do have a stroke, they are less likely to die from one, according to a new study. Researchers attribute the lower risk of stroke to better management of stroke risk factors, such as keeping down high blood pressure.

In the study, 15,792 residents from four U.S. communities who were ages 45 to 64 when the study began in 1987 to 1989. Researchers ended up following 14,357 participants through the end of 2011 with exams, phone interviews discharge surveillance, and other measures.

Researchers found there was a 24 percent overall decline in first-time strokes in participants during the last two decades and a 20 percent overall drop per decade in deaths after stroke.

“We can congratulate ourselves that we are doing well, but stroke is still the No. 4 cause of death in the United States,” says study co-author Josef Coresh, MD, PhD, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. “This research points out the areas that need improvement. It also reminds us that there are many forces threatening to push stroke rates back up and if we don’t address them head-on, our gains may be lost.”

For example, Coresh says it is unclear how the outlook for stroke will be in the future, as more and more Americans become obese, or develop high blood pressure or diabetes, which increase stroke risk.

Seven percent of participants had a stroke during the study period, and 10 percent died within 30 days; 21 percent died with a year; 40 percent died within five years; 58 percent died by the end of the study in 2011. Each decade, the number of deaths occurring within 10 years of a stroke was reduced by roughly eight deaths per 100 cases.

The researchers note that the reduction in strokes is attributable to better control of risk factors for stroke, such as high blood pressure, smoking cessation, and the use of cholesterol-lowering medications. According to the American Heart Association stroke is the number four cause of death and a leading cause of adult disability in the United States. On average, every 4 minutes someone dies of a stroke.

“Stroke is not only one of the main causes of death, but a leading cause of long-term disability in adults. Therefore, prevention is the best strategy,” says study leader Silvia Koton, PhD, MOccH, a visiting faculty member at the Bloomberg School and incoming nursing department chair at Tel Aviv University.

In this study, researchers also determined each medical chart of people with stroke using uniform criteria. They focused on deaths from all causes becausemany stroke patients die from other underlying causes including heart disease and pneumonia.

“Since rates are not equally falling across the board, physicians and policymakers need to pay closer attention to specific subgroups,” Koton says. “These data are also helpful in monitoring the results of how we care for people of all ages, hopefully helping them even before they have a stroke.”

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