Most Important Outcomes Research Papers on Stroke and Transient Ischemic Attack

Each year in the United States, approximately 800 000 men and women are affected by stroke, which equates to one incident of stroke every 40 seconds.1 Stroke is the fourth leading cause of death nationally and is one of the foremost contributors to functional disability.2 The cost to the US healthcare system is substantial. Specifically, in 2010 medical treatment for stroke cost approximately $54 billion and is expected to exceed $1 trillion by 2050.3 The burden of stroke is not limited to US alone; mortality from stroke is responsible for ~9% of all deaths worldwide and is the second most common cause of death following ischemic heart disease.4 While the overall risk of stroke has declined by 25% in the last decade,5 disability from stroke is now emerging as a major public health problem, particularly in the elderly, as we observe an increase in aging of the population. Accordingly, in this month’s topic review in Circulation: Cardiovascular Quality and Outcomes , we concentrate on contemporary issues around stroke and transient ischemic attack (TIA). Significant knowledge and practice gaps continue to exist across the continuum of stroke care. First, risk factor modification for stoke remains suboptimal. The most important modifiable risk factor for prevention of stroke is hypertension (HTN), with the lowering of blood pressure associated with a more than 25% reduction in the relative risk (RR) of stroke.6,7 Modification of other risk factors such as diabetes, hypercholesterolemia, smoking cessation and atrial fibrillation (AF),8 have also been shown to reduce the incidence of stroke.9 However, appropriate identification of patients at risk and ensuring adherence to prevention strategies presents many challenges. For example, numerous patients with HTN are not on therapy and many of those who are treated have suboptimal blood pressure …