Key New Zealand health target must change, says Professor
One of New Zealand’s top six priority health targets needs revision, according to the lead author of a study published in Nature Reviews Neurology.
The Ministry of Health is targeting 90 per cent screening for cardiovascular risk, which shares risk factors with other major non-communicable diseases (NCDs) such as stroke, diabetes and dementia. However, the research paper shows that the burden of stroke and other NCDs is increasing rapidly both in New Zealand and internationally, and the high-risk prevention approach being taken globally is inadequate.
“The evidence is clear. Simply screening for high levels of cardiovascular risk, even with some counselling, is not effective in reducing incidence or mortality from cardiovascular disease,” says Valery Feigin, lead author and Professor of Neurology and Epidemiology at Auckland University of Technology (AUT).
He points to findings from the study, which analysed the most recent literature on stroke epidemiology. “There is evidence from 240,000 participants in randomised clinical trials that screening for cardiovascular risk had no effect on health outcomes ten years on. The health target should be a reduction in cardiovascular risk,” he says.
Although global stroke incidence and mortality declined from 1990 to 2013, the absolute numbers of people affected by stroke is rising rapidly throughout the world. This increasing burden of stroke, including the lifelong disability many stroke survivors suffer, indicates deficiencies in current stroke prevention strategies. These deficiencies are further highlighted by significant gender and ethnic disparities, and a trend towards more strokes in younger people.
According to Professor Feigin, current screening measures give false reassurance to people classified as low to moderate risk – the group in which approximately 80 per cent of all strokes occur. Some of these individuals have isolated hypertension and many have other risk factors. With the exception of smoking however, behavioural risk factors such as poor diet, sedentary lifestyle and excessive alcohol intake are not usually included in the cardiovascular risk algorithms that are currently used. This is despite the fact that nearly three quarters of the global burden of stroke is linked to lifestyle choices.
“Stroke is largely a lifestyle disease. With better strategies in place, we could prevent three quarters of all strokes and heart attacks, and extend our stroke, heart attack, dementia and diabetes-free lives by 20-30 years,” he says.
Professor Feigin and his co-authors recommend governments introduce taxation to control nutritional, alcohol and tobacco-related risks – a proven risk mitigation method that would generate funding for population wide prevention initiatives and abolition of the emphasis on high risk individuals.
“Over the last 30 years, New Zealand has experienced a three-fold increase in the number of people affected by stroke and living with stroke consequences, and most have very limited access to rehabilitation services. Developing resources at the same pace as stroke survivors is not feasible. The only solution is primary prevention,” says Professor Feigin.
The President of the World Stroke Organization, Professor Stephen Davis, has welcomed the insights provided by the study.
“Given the dramatically increasing global burden of stroke, this call to action in stroke prevention, from Feigin, Norrving and colleagues, is strongly supported by the World Stroke Organization. They have highlighted the importance of a comprehensive population-based approach to primary stroke prevention, integrated with strategies for other non-communicable diseases with similar risk factors. This should include early life interventions. They have highlighted behavioural, lifestyle and environmental factors and the potential for specific revenue-raising to support these initiatives. They have also indicated the potential of using electronic information technology such as smartphone apps,” he says.
“These strategies could potentially save millions of lives and have a huge impact on the burden of disability after stroke,” says Professor Davis.