The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs).

 This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy.

 (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia.

 (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs.

 (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point.

Conclusion

An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.

中文翻译：

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预防原发性卒中的多层次社区干预：世界卒中组织的一种概念方法

中风和痴呆症的负担日益增加，这强调了对新的，耐受性良好且具有成本效益的初级预防策略的需求，这些策略可以降低全球范围内，特别是在中低收入国家（LMIC）中风和痴呆症的风险。

 本文概述了三种主要的中风预防策略的概念框架：（a）“多药丸”策略；（b）“全民”战略；（c）“全民激励”战略。

 （a）含通用低剂量血压成分和降脂药物（例如坎地沙坦16毫克，氨氯地平2.5毫克和瑞舒伐他汀10毫克）的多药丸似乎是一种安全且具有成本效益的方法，可用于初级预防中风和痴呆。

 （b）降低风险水平的整个人群的策略是最有效的一级预防策略，无论其风险水平如何。改变健康行为（例如吸烟，饮食，体育锻炼）的激励性全民策略应基于认知行为疗法的原则。智能手机等移动技术即使在LMIC中也提供了行为干预（例如Stroke Riskometer应用程序）的理想界面。

 （c）社区卫生工作者可以改善维持生活方式的变化以及对药物的依从性，特别是在资源贫乏地区。关键是要对社区卫生工作者进行适当的培训。

结论

在全球范围内，有效的初级卒中预防策略应将药理学（多药丸）和生活方式改变（动机性全人群策略）干预措施相结合。预计这种综合方法的副作用极小，中低中风风险个体的获益可能很大。将来，实用的现场试验将提供更多的证据。