Stroke deaths decline in Europe—but improvement is needed

New research published in the European Heart Journal highlights how overall cerebrovascular disease deaths in Europe have declined. But that improvement has leveled off in some EU countries.

Cerebrovascular disease accounts for 9 percent of deaths in European men and 13 percent for European women.

"Over the last 35 years there have been large overall declines in deaths from cerebrovascular disease in the majority of European countries,” said lead author Nick Townsend, PhD, of the University of Bath in the United Kingdom, in a prepared statement issued by the European Society of Cardiology. “While these declines have continued in more than half of the countries, these have not been consistent across Europe and our analysis has revealed evidence of recent plateauing and even increases in stroke deaths in certain countries.”

Townsend and colleagues utilized data from the World Health Organization (WHO) to assess mortality trends in three types of cerebrovascular disease—ischemic stroke, hemorrhagic stroke and sub-arachnoid hemorrhage between 1980 and 2016. Among the notable findings:

  • Overall, death rates from all three types of disease decreased in 33 countries.
  • The incidence of stroke death was higher in females in 50 of the 51 countries with available data. They were much lower in Western Europe than the rest of the continent.
  • More than one-third of countries showed a slowing of the decrease in death rates from stroke, no decrease or an increase in the most recent trend observed.
  • There was evidence of a recent plateau in mortality trends in seven countries for men and six countries for women, mostly in Western Europe.
  • Most countries with available data had significant decreases in age-standardized death rates from ischemic and hemorrhagic stroke.
  • Increases in ischemic stroke death rates were seen in eight countries for men and nine countries for women.
  • There were no increases seen for hemorrhagic stroke.
  • Increases in sub-arachnoid hemorrhage were seen in two countries for men and four countries for women.
  • Sub-arachnoid hemorrhage in women was the only type of stroke for which more countries exhibited a plateau or increasing trends than decreases in recent years.
  • A less pronounced decrease, no significant change or a significant increase in death rates from sub-arachnoid was found in 25 countries for women.

The researchers noted it was unlikely the overall decline in cerebrovascular disease could be attributed to one cause. However, they noted new pharmaceutical therapies, surgical techniques and prevention strategies most likely played a role in the decline.

They also added the increasing prevalence of obesity, diabetes and higher cholesterol levels in recent years may be possible contributors to plateaued or increasing death rates.

"Our findings highlight a need to counter inequalities by understanding local contexts in disease occurrence and treatment,” Townsend et al. concluded. “In particular, we need to encourage the implementation of evidence-based recommendations in the prevention and treatment of stroke in all countries. Many countries have been able to reduce the mortality burden from stroke in recent years. We must understand why this is not happening in all countries and identify barriers to the implementation of evidence-based recommended practice in countries that are slow to adopt them. In addition, we only studied between-country inequalities, but we must consider within-country inequalities as well if we are to have an impact on the disease."