Stroke prevention. An opportunity for efficient utilization of health care resources during the coming decade.

BACKGROUND: Stroke is unique among neurological diseases, since it has a high prevalence and burden of illness, high economic cost, and is preventable. Epidemiological approaches to stroke prevention include the "high-risk" and "mass" approaches. In this review we discuss these preventive strategies, target host and discretionary risk factors that are amenable to these measures, and discuss potential cost savings. SUMMARY OF REVIEW: Projected numbers of strokes prevented for specific stroke risk factors were estimated by using the population-attributable risk estimation for hypertension, cigarette smoking, atrial fibrillation, and heavy alcohol consumption. The projected numbers of strokes that could be prevented were substantial and highest for hypertension and cigarette smoking. Projected yearly cost of stroke associated with these two treatable factors was also substantial.
CONCLUSIONS: The prevention of stroke can be accomplished by the high-risk or mass approach or a combination of these approaches. The high-risk approach prevents strokes but is also expensive. The mass approach may be more cost-effective, which could lead to substantial savings, but this needs to be investigated.