On the 40th anniversary of the journal Stroke: Journal of the American Heart Association, stroke leaders from around the world celebrated stroke research accomplishments and set an agenda for the future, according to a special report in the journal.
"The past 40 years have seen more advances in stroke than the previous four millennia," said Vladimir Hachinski, M.D., editor of Stroke and distinguished university professor of neurology at the University of Western Ontario in London, Canada. "We've accomplished a lot but we need to accelerate that progress."
Since 1970, stroke advances include: identification of stroke risk factors such as hypertension, evidence that anti-platelet drugs can prevent stroke, the formation of dedicated stroke units and the approval of a clot-busting drug to treat acute stroke.
For the journal anniversary, seven working groups of stroke leaders made recommendations for the future direction of stroke research on specific topics.
"The participants made prevention a top priority," Hachinski said. "That's where the biggest gaps currently are, and the largest potential gains for greater effort.
" Although stroke is preventable, it is increasing globally. While a few known risk factors (such as high blood pressure) account for many leading health problems in the world, they remain uncontrolled in most people."
The recommendations from the seven working groups include:
- Basic science, drug development and technology: Encourage collaboration between specialists. For example, laboratory scientists and clinicians could work more closely on specific stroke problems, and stroke researchers could pursue common mechanisms that are involved in other neurological diseases of the aging brain (such as Parkinson's and Alzheimer's disease).
- Stroke prevention: Make stroke a major focus of chronic disease prevention globally. Recognize the importance of severely disabling strokes and common and subtle subclinical strokes that disrupt executive functioning (such as the ability to plan and prioritize tasks).
- Acute stroke management: Continue establishing specialized treatment centers that have improved outcomes, including stroke centers, hospital stroke units, regional systems of emergency stroke care, and telecommunications networks to guide treatment in isolated areas.
- Brain recovery and rehabilitation: Standardize post-stroke rehabilitation based on the best evidence from research and continue rigorous clinical research.
- Web, technology and communications: Work towards global unrestricted access to stroke-related information for better public education, easier communication between professionals, and a way for patients to connect with their physicians and peers. Build centralized electronic archives and registries.
- Stakeholders: Foster cooperation among large stroke organizations, nongovernmental organizations, governments, patient organizations and industry to enable joint educational efforts and enhance stroke care.
- Education of professions, patients, the public and policy makers: Promote the concept of "Brain Health" to encourage prevention.
Coalitions will be vital in reducing the amount of death and disability from stroke, Hachinski said. "Stroke is a big problem, but still a small professional field. We need to work very closely with the public, health practitioners and other health organizations to protect brains and prevent strokes."
The group also said evidenced-based treatment will probably save time, money and effort.
"Although the challenges are daunting, the achievements of the past four decades are inspiring . . . [and the field] is ripe for further advances in prevention, acute treatment and rehabilitation," the authors wrote.
The report will also be published in Cerebrvascular Diseases; and The International Journal of Stroke.
Co-authors are: Geoffrey A. Donnan, M.D.; Philip B. Gorelick, M.D., M.P.H.; Werner Hacke, M.D., Ph.D.; Steven C. Cramer, M.D.; Markku Kaste, M.D., Ph.D.; Marc Fisher, .M.D.; Michael Brainin, M.D.; Alastair M. Buchan, D.Sc., L.L.D.; Eng H. Lo, Ph.D.; Brett E. Skolnick, Ph.D.; Karen L. Furie, M.D., M.P.H.; Graeme J. Hankey, M.D.; Miia Kivipelto, M.D., Ph.D.; John Morris, M.D.; Peter M. Rothwell, M.D., Ph.D.; Ralph L. Sacco, M.D., M.S.; Sidney C. Smith, Jr., M.D.; Yulun Wang, Ph.D.; Alan Bryer, Ph.D.; Gary A. Ford, M.D.; Costantino Iadecola, M.D.; Sheila C.O. Martins, M.D., Ph.D.; Jeff Saver, M.D.; Veronika Skvortskova, M.D.; Markk Bayley, M.D.; Martin N. Bednar, M.D., Ph.D.; Pamela Duncan, Ph.D.; Lori Enney; Seth Finklestein, M.D.; Theresa A. Jones, Ph.D.; Lalit Kalra, M.D., Ph.D.; Jeff Kleim, M.D.; Ralph Nitkin, Ph.D.; Robert Teasell, M.D.; Cornelius Weiller, M.D.; Bhupat Desai, M.D.; Mark P. Goldberg, M.D.; Wolf-Dieter Heiss, M.D.; Osmo Saarelma, M.D.; Lee H. Schwamm, M.D.; Yukito Shinohara, M.D.; Bhargava Trivedi, M.D.; Nils Wahlgren, M.D.; Lawrence K. Wong, M.D.; Antoine Hakin, M.D., Ph.D.; Bo Norrving, M.D., Ph.D.; Stephen Prudhomme, M.S.; Natan M. Bornstein, M.D.; Stephen M. Davis, M.D.; Larry B. Goldstein, M.D.; Didier Leys, M.D., Ph.D.; and Jaakko Tuomilehto, M.D., Ph.D. Author disclosures are on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
NR10 1079 (Stroke/Hachinski)
Contact information: Dr. Hachinski can be reached at (519) 663-3624 or Vladimir.Hachinski@LHSC.ON.CA . (Please do not publish contact information.)
Editor's note: May is American Stroke Month.
Additional resources:
For more information on stroke, visit the American Stroke Association Web site: strokeassociation.org
Downloadable video interview clips with Ralph Sacco, M.D., neurologist and President-elect of the American Heart Association may be found here.