A New Model For Stroke Prevention

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Background

While the incidence and mortality from stroke in the United States has declined in the past 20 years, there are still more than 795,000 strokes per year, of which 185,000 are recurrent events. There remains great disparity in these rates across racial groups –the incidence and mortality among African Americans, is two to four times higher than Non-Hispanic Whites. Stroke remains the second leading cause of death in the world and a major cause of disability, and its burden is expected to increase with the aging of the population
Despite great advances in drug therapies, the impact on stroke prevention has not been fully realized. There is a need for improved delivery of effective treatments in order to maximize the impact on the population.
Recently, several randomized clinical trials have demonstrated the effectiveness of a comprehensive; clinic based, navigator-assisted approach to disease management, although in the context of specific clinical situations. For example, the SAMMPRIS study for treatment of symptomatic intracranial atherosclerosis. In this study, the medical arm, which consisted of dual antiplatelet therapy, high potency statins and a program of lifestyle modification, demonstrated better outcomes than the interventional arm (angioplasty and stent). The Look AHEAD study evaluated an Intensive Lifestyle Intervention (ILI) and found better rates of diabetes remission in the group randomly assigned to ILI. In 2013, the PREDIMED group reported the results of a large randomized trial of a Mediterranean vs. a low fat dietary pattern and demonstrated decreased rates of cardiovascular disease and especially stroke in the group randomized to a Mediterranean style diet.
These studies are encouraging and support the idea of a prevention program that is organized around lifestyle changes. One of the challenges is making such intensive interventions sustainable and with long-term efficacy. A new model of stroke prevention is needed.
We propose that learning from the development of the “stroke center” for acute stroke care, we may apply a similar model to stroke prevention. The introduction of thrombolytic therapy for the acute treatment of stroke brought a revolutionary change to the care of stroke patients because of the organization required for implementing treatment with IV tPA. This resulted in improved outcomes for all patients with stroke, not just those eligible for thrombolytic therapy.
We believe that Stroke Prevention Clinics, organized like outpatient “stroke centers”, offering evaluation, treatment, and long-term follow up of patients for risk factor control and lifestyle interventions for secondary prevention, may offer benefit in further reducing stroke incidence and mortality as well as decreasing the disparities that currently exist.
The aim of this Research Topic is to encourage investigators to submit their work on new models of care for prevention of stroke. We welcome participation in the form of original research about specific interventions for risk factor control, research about new approaches for delivery of care, reviews of risk factor management programs, and opinion statements presenting novel approaches to stroke prevention.

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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