15 Global burden of stroke CYAN MAGENTA YELLOW BLACK

Treatinghypertensioncan reducethe riskof a strokeby up to40%.

Stroke burden

is projected to rise

from around

38 million DALYs

globally in 1990 to

61 million DALYs

in 2020.

Stroke is the

biggest single

cause of major

disability in the

United Kingdom.

TUVALU

MARSHALL ISLANDS

NAURU

TONGA

SAMOA

NIUE

COOKISLANDS

KIRIBATI

FIJI

VANUATU

REP.KOREA

DPRKOREA

TIMOR-LESTE

ANTIGUA & BARBUDA

BARBADOS

ST LUCIA

TRINIDAD & TOBAGO

PALAU

ST KITTS & NEVIS

ST VINCENT & GRENADINES

BAHAMAS

ZIMBABWE

UGANDA

TURKMENISTAN

UZBEKISTAN

TAJIKISTAN

KYRGYZSTAN

GEORGIAAZERBAIJAN

MADAGASCAR

SRI LANKA

JAMAICA

CUBA

DOMINICANREP.

BRUNEI DAR.

M A L A Y S I A

SAUDI ARABIA

C H I N A

MONGOLIA

VIET NAM

CAMBODIA

LAOPDR

THAILAND

I N D I A

BHUTAN

BANGLADESH

ISL . REP .IRAN

PAKISTAN

AFGHANISTAN

T U R K E Y

IRAQ

CYPRUS SYRIAN ARAB REPUBLIC

LEBANONISRAEL

JORDAN

BAHRAINQATAR

UAE

OMAN

KUWAIT

YEMEN

NEPAL

K A Z A K H S T A N

U S A

C A N A D A

ALGERIA

NIGERCHAD

S U D A N

NIGERIA

DEM. REP.CONGO

ETHIOPIA

ANGOLA

E G Y P T

MOROCCO

LIBYANARAB

JAMAHIRIYA

MAURITANIA

SENEGALGAMBIA

CAPE VERDE

SAO TOME & PRINCIPE

GUINEA-BISSAUGUINEA

LIBERIA

CÔTE D’IVOIRE

BURKINAFASO

GH

ANA

BEN

IN

CAMEROONEQUATORIALGUINEA

GABON

CONGO

NAMIBIABOTSWANA

SOUTH AFRICA

MOZAMBIQUE

MALAWIZAMBIA

UNITED REP.TANZANIA

KENYA

DJIBOUTI

TOG

O

SIERRA LEONE

MALI

ERITREAGUATEMALA

EL SALVADOR

MEXICO

HAITI

BOLIVIA

PARAGUAY

B R A Z I L

VENEZUELA

COLOMBIA

HONDURAS

NICARAGUA

COSTA RICA

PANAMA

ECUADOR

PERU

GUYANASURINAME

BELIZE

ARGENTINA

URUGUAY

CHILE

PHILIPPINES

NEW

ZEALAND

PAPUANEW

GUINEAI N D O N E S I A

JAPAN

R U S S I A N F E D E R A T I O N

MAURITIUS

MALDIVES

COMOROS

SEYCHELLES

SINGAPORE

GRENADA

MYANMAR

SOLOMONISLANDS

TUNISIA

A U S T R A L I A

CENTRAL AFRICANREPUBLIC

BURUNDI

RWANDA

SWAZILAND

LESOTHO

ARMENIA

SOMALIA

DOMINICA

age 17–49 yearsIsrael

15–44Italy

Florence

15–44ItalyNorth

0–39Kuwait

40–49Kuwait

15–40LibyanArab

JamahiriyaBenghazi

20–54South Africa

Blacks

11–50Spain

Cantabria

20–44USA

NorthernManhattan

Blacks

20–44USA

NorthernManhattan

Hispanics

20–44USA

NorthernManhattan

Whites

109

14

3

4747

33

14

2526

10

Stroke in young peopleNumber of new cases of strokeper 100 000 people per yearselected populations1986–1997

CROATIA

ITALY

REP.MOLDOVA

UKRAINE

FYR MACEDONIA

LITHUANIA

LATVIA

ESTONIA

ALBANIA

AUSTRIA HUNGARY

BULGARIA

ROMANIA

GREECE

SERBIA &MONTENEGRO

POLAND

SLOVENIA

BELARUS

RUSSIANFEDERATIONUNITED

KINGDOM

IRELAND

DENMARK

FRANCE

SPAIN

ANDORRA

S. MARINO

PORTUGAL

GERMANY

SWITZ.

BELGIUM

LUX.

NETH.

ICELAND

NORWAY

FINLAND

SWEDEN

SLOVAKIACZECHREPUBLIC

MALTA

MONACO

BOSNIA & HERZEGOVINA

DALYs lost per 1000 population, age-standardized2002 Disability-adjusted life years combine years of potential life lost due to premature death with years of productive life lost due to disability

20 and above

15–19

10–14 no data

5–9

below 5

Healthy years of life lost to stroke

5150

Global burden of stroke 15“I waked and sat up…when I felt a

confusion and indistinctness in my head which lasted, I suppose about half a

minute. Soon after I perceived that I had suffered a paralytick stroke, and that my

Speech was taken from me.”Samuel Johnson, England, 1783

Stroke is the brain equivalent of a heart attack. Blood must flow to and through the brain for it to function. If its flow is obstructed, by a blood clot moving to the brain, or by narrowing or bursting of blood vessels, the brain loses its energy supply, causing damage to tissues leading to stroke.

Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community. Stroke is uncommon in people under 40 years; when it does occur, the main cause is high blood pressure. Stroke also occurs in about 8% of children with sickle cell disease.

The major risk factors for stroke are similar to those for coronary heart disease, with high blood pressure and tobacco use the most significant modifiable risks. Atrial fibrillation, heart failure and heart attack are other important risk factors.

The incidence of stroke is declining in many developed countries, largely as a result of better control of high blood pressure, and reduced levels of smoking. However, the absolute number of strokes continues to increase because of the ageing population.

The increased risk of stroke from taking oral contraceptive pills is substantially reduced by using the modern, low-dose pill.