October 29th is celebrated World Stroke Day (World Stroke Day), acute cerebrovascular disease caused by sudden obstruction (by a thrombus or embolus; ischemic stroke) or from break (haemorrhagic stroke) of a blood vessel supplying theencephalon.
The stroke mortality he was born in 20-30% 30 days after the event and 40-50% one year laterwhile 75% of surviving patients have some form of disability which in half of the cases leads to loss of self-sufficiency.
The prevalence and incidence of stroke increase with age, particularly from age 55; after the age of 65 the increase in incidence is exponential.
Stroke represents an important public health problem due to its diffusion in the population and the seriousness of the consequences on those affected and often involves considerable involvement of the patient’s family members and caregiver with significant economic and social costs.
Objective from the Day 2023 is to raise awareness among the population of the importance of preventing this serious brain pathology, underlining that it is estimated that 90% of strokes could be prevented by acting on the main modifiable risk factors
Epidemiological data
The stroke mortality he was born in 20-30% 30 days after the event and 40-50% one year later, while 75% of surviving patients have some form of disability which in half of the cases leads to loss of self-sufficiency. The prevalence and incidence of stroke increase with age, particularly from age 55; after the age of 65 the increase in incidence is exponential.
Globally: it is estimated that in 2019 the stroke caused 6.55 million deaths (84.2 per 100,000), resulting in the second cause of death after ischemic heart disease, with an incidence of 12.2 million cases (150.8 per 100,000) and a prevalence of 101 million cases (1,240.3 per 100,000).
More frequent is the ischemic form of strokewhich caused 3.29 million deaths (43.5 per 100,000) with an incidence of 7.63 million cases (94.5 per 100,000) and a prevalence of 77.2 million cases (951 per 100,000). They follow theintracerebral hemorrhagecause of 2.89 million deaths (36 per 100,000) with an incidence of 3.41 million cases (41.8 per 100,000) and a prevalence of 20.7 million cases (248.8 per 100,000), elsubarachnoid hemorrhagecause of approximately 373 thousand deaths (4.7 per 100,000) with an incidence of 1.18 million cases (14.5 per 100,000) and a prevalence of 8.4 million cases (101.6 per 100,000).
In Europa: the fifth edition of European Cardiovascular Disease Statistics indicates stroke as the second leading cause of death in Europe, with 405,000 deaths (9%) in men and 583,000 (13%) deaths in women.
In Italy: in 2020 have been registered 76,890 hospitalizations for acute care in the ordinary regime for stroke (code 014 – Intracranial hemorrhage or cerebral infarction) and 57,631 deaths from cerebrovascular diseases (23,139 males and 34,492 females), which represent 7.7% of all deaths that occurred in our country in that year when the COVID-19 pandemic began.
Thanks to the improvement in the effectiveness of preventive, therapeutic and care measures for stroke and related risk factors, including the greater diffusion throughout the national territory of Center Stroke from StExchange Unit, in recent decades a progressive reduction in the incidence and mortality from cerebrovascular diseases has been observed.
What to do if symptoms related to a stroke appear
Prevention is essential, but it is also very important to know what to do in the event of the sudden onset of symptoms related to a stroke. Stroke, in fact, is a “time-dependent” pathology: during ischemia, the sooner one intervenes and the more brain cells can be saved (“time is brain”), allowing for better recovery from the stroke. The maximum effectiveness of reperfusion treatments is achieved if they are undertaken within 4.5-6 hours of the onset of symptoms.
Therefore, in the event of the APPEARANCE of one or more symptoms attributable to stroke which
sudden reduction or loss of motility and strength and/or sudden sensory deficits (tingling, loss of sensitivity) in the lower half of the face (with asymmetry of the mouth which appears “crooked” especially when the patient tries to smile), in the arm and/or or the leg of one side of the body
sudden difficulty in speaking and/or understanding the language of others sudden visual disturbances in one or both eyes sudden loss of coordination of movements, sensation of dizziness, dizziness and/or falling to the ground sudden excruciating and unusual headache
it is necessary to IMMEDIATELY CALL 112/118 for urgent transport to the emergency room of a hospital where specialist stroke care is provided (SExchange Unit). Do not wait to see if the symptoms improve spontaneously, do not contact your general practitioner (GP) or the emergency medical service and do not go to the emergency room by your own means, also to avoid going to a hospital where there is no active Stroke Unit.
The acronym FASTused by Americans, allows you to easily remember some tests to do when you suspect that a person has had a stroke (Cincinnati Prehospital Stroke Scale):
F (like Face): ask the person to smile and observe whether a corner of the mouth does not rise or “falls” and the mouth appears “crooked”;
A (as Arms): ask the person to raise both arms and observe whether he has difficulty/inability to raise one arm or keep it raised at the same level as the other;
S (such as Speech: language): ask the person to repeat a simple sentence and evaluate whether their way of speaking is strange (nonsense words) or slurred;
T (like Time: time): if any of these signs is present, you must CALL 112/118 IMMEDIATELY.
The main modifiable risk factors
Modifiable risk factors include:
smoking (smoking and use of other tobacco and nicotine products); sedentary lifestyle/insufficient physical activity; incorrect diet (unbalanced and high-calorie; rich in fats, sugars and salt; low in fruit and vegetables); overweight and obesity; hypertension; dyslipidemia (increased cholesterol and/or triglyceridemia values); diabetes mellitus; atrial fibrillation; heart disease (ischemic heart disease, cardiomyopathy, heart valve disease, patent foramen ovale, atrial septal aneurysm); vasculopathies (atheromasic lesions of the aortic arch, carotids and intracranial vessels; cerebral aneurysms).
Other modifiable risk factors are bleeding and thrombophilic disorders, sickle cell anemia, chronic kidney disease (CKD), obstructive sleep apnea syndrome (OSAS), use of oral contraceptives, hormone replacement therapy ( Hormone Replacement Therapy, HRT) during menopause and drug use (cocaine; methamphetamine or similar products such as ecstasy and amphetamine; opiates, particularly heroin).
Prevention
The prevention represents themost effective weapon to reduce cases of stroke and other cardio-cerebrovascular diseases and is essentially based on:
adoption and maintenance of lifestyles healthy (do not smoke or consume other tobacco products; regularly practice adequate physical activity; avoid risky and harmful consumption of alcohol; follow a healthy, varied and balanced diet, favoring the consumption of fruit, vegetables, whole grains and fish and limiting the intake of salt, red meat, fats of animal origin and sugars; maintain an optimal body weight),
early identification and adequate management of any factors that significantly increase the risk of strokesuch as arterial hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, heart disease and vascular disease.
The Ministry of Health supports the prevention of stroke and, more generally, of cardio-cerebrovascular diseases as a priority objective for combating chronic non-communicable diseases, in particular through the National Prevention Plan (PNP) 2020-2025 and the Alliance Italian for cardio-cerebrovascular diseases.
The National Prevention Plan 2020-2025
Il National Prevention Plan (PNP) 2020-2025adopted with the State-Regions Agreement of 6 August 2020, in continuity with the previous ones, confirms the intersectoral approach, by setting and by life cycle, consolidating the Regions’ commitment to health promotion, prevention and strengthening of targeted interventions the early identification of subjects at risk for chronic non-communicable diseases, including cardio-cerebrovascular diseases, and their direction towards adequate “care”.
All the Regions and Autonomous Provinces have prepared and adopted their Regional Prevention Plan (PRP) by 31 December 2021, in which the contents, objectives and lines of action of the PNP 2020-2025 have been set out; The implementation of PRPs within territorial contexts is underway.
The Italian Alliance for Cardio-Cerebrovascular Diseases
It is a voluntary Alliance that aims to bring the institutional level closer to the clinical one, bringing together all the main stakeholders in a permanent discussion table with the common objective of promoting and implementing interventions for the promotion of health, prevention and control of cardiovascular diseases. cerebrovascular disease, in line with the “Gaining health: making healthy choices easy” programme, the National Prevention Plan and the National Chronicity Plan, in order to reduce its incidence, morbidity and mortality in the long term.
It was established on 18 May 2017 at the Ministry’s Directorate General for Health Prevention and currently includes forty-eight Federations/Societies of cardiology and neurology, internal medicine, general practitioners, paediatricians, pharmacists, as well as patient associations and other bodies. .
As part of the activities carried out by the Alliance, the scientific document “Prevention of cerebrovascular diseases throughout life”, the “Information document for citizens on the prevention of cerebrovascular diseases throughout life”, and two information leaflets (“Cerebrovascular diseases – What they are and what to do to prevent and deal with them” and “Cerebrovascular diseases – How to prevent stroke in women”).
The new ones have recently been defined linee operative of the Alliance and activated 4 working groups, one of which is specifically involved in the development of a low intensity rehabilitation care model for the long-term care of stroke survivors; the other groups also concern important issues for cerebrovascular diseases: therapeutic adherence as a necessary tool to guarantee an effective treatment path; assessment of individual cardiovascular risk: examination of available calculators and adoption of the most suitable and usable tools in our country; impact of air pollution on cardiovascular diseases.
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