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Image representing a stroke

Differences in stroke death rates across Europe 

In Europe, stroke accounts for over one in ten deaths each year and is the second largest cause of death after heart disease. New research, published in the European Heart Journal, has found that deaths from cerebrovascular disease are declining overall in Europe but that in some countries the decline is levelling off or increasing. 

The study used data from the World Health Organization (WHO) to examine mortality trends in ischaemic stroke (lack of blood flow to the brain), haemorrhagic stroke (bleeding in the brain) and sub-arachnoid haemorrhage, (bleeding between the brain and its surrounding membrane) in European countries between 1980 and 2016. Data were only available by stroke subtype for 43 countries and most of the countries with missing data were in Eastern Europe and Central Asia. 

During the 35-year period studied, stroke-related mortality declined across Europe and, on average, the annual  percentage change for countries included in the study was -2.3% for men and -2.5% for women. However, the decline in stroke-related deaths was more frequent and steeper in Western Europe and less frequent and steep in Eastern Europe. 

The researchers found evidence of a recent plateau in stroke-related mortality in nine countries and an increase in five countries. There was a particularly notable increase in stroke-related deaths over the study period in Bosnia, Uzbekistan and Macedonia. 

Co-author Dr Lucy Wright, Cardiovascular Epidemiologist, said: “It is important to look at each type of stroke separately. In the most recent period, there were increases in ischaemic stroke in eight countries among men and nine for women, increases in haemorrhagic stroke in three countries in men and one for women, and increases in sub-arachnoid haemorrhage in five countries for men and eight countries for women.” 

The reasons for the overall decline in stroke–related mortality across Europe and recent plateau or increase in stroke-related mortality in some European countries are not completely understood. 

Commenting on the study in an editorial in the European Heart Journal, Prof Chris Gale and Prof Barbara Casadei suggest that the decline in stroke-related mortality has been influenced by factors including understanding the causal relationship between blood pressure and vascular events, the treatment of hypertension at scale, and a decline in recurrent strokes. Factors such as improved detection and treatment of diabetes and dyslipidaemia (high levels of lipids such as cholesterol in the blood), smoking cessation, and changes in diet and levels of exercise, are also thought to be relevant.

However, the geographical differences in stroke-related mortality suggest that the opportunity to prevent deaths from stroke has not been fully realised, and that local and international quality improvement initiatives are needed.

Prof Casadei, British Heart Foundation Professor of Cardiovascular Medicine at the University of Oxford, and President of the European Society of Cardiology, said: “The evidence of plateauing among nine countries and the upturn in stroke-related deaths in five countries is concerning. Health disparities need to be addressed and innovative strategies to change behaviour adopted in order to improve the cerebrovascular health of the population.”