ABSTRACT

In this narrative review article, by critically appraising the Global Burden of Disease 1990–2017 data on stroke and currently used primary stroke prevention strategies, we show that the global burden of stroke will continue to rise unless new primary stroke and cardiovascular disease (CVD) prevention strategies are urgently implemented. We provide an overview of the advantages and disadvantagesof population-wide and high CVD risk prevention strategies and mobile technologies available for stroke and CVD prevention on individual and population levels. Our recent NZ pilot RCT demonstrated the feasibility, consumer acceptability, motivational value and a clinically important, albeit statistically non-significant, behaviour change, improvement in diet, and awareness of stroke symptoms. We also identify and discuss causes for failure in the currently used primary stroke and CVD prevention strategies and emphasise the importance of complementary use of population-wide and elevated CVD risk strategies (including polypill interventions with blood pressure and lipid-lowering off-patent medications in middle-aged adults with elevated CVD risk) with motivational population-wide strategy to manage lifestyle and behavioural risk factors regardless of the level of stroke risk. The best mix of population-wide and elevated CVD risk-targeted strategiesfor primary stroke and CVD prevention remains to be determined.

摘要

在这篇叙述性评论文章中，通过批判性评估 1990-2017 年全球疾病负担关于卒中和目前使用的初级卒中预防策略的数据，我们表明全球卒中负担将继续上升，除非新的原发性卒中和心血管疾病 (CVD)紧急执行预防战略。我们概述了人群范围内和高 CVD 风险预防策略以及可用于个人和人群水平的卒中和 CVD 预防的移动技术的优缺点。我们最近的新西兰试点 RCT 证明了可行性、消费者可接受性、激励价值以及临床上重要的（尽管统计上不显着）行为改变、饮食改善和对中风症状的认识。我们还确定和讨论了当前使用的原发性卒中和 CVD 预防策略失败的原因，并强调补充使用全人群和升高的 CVD 风险策略（包括多药干预与血压和降脂非专利药物）的重要性。 CVD 风险升高的中年成年人）采用激励性的全人群策略来管理生活方式和行为风险因素，无论中风风险水平如何。用于原发性卒中和 CVD 预防的人群范围和 CVD 风险升高的目标策略的最佳组合仍有待确定。