Improving Access to Primordial and Primary Stroke Prevention: Global Considerations

Stroke is the second-leading cause of death and the third-leading cause of disability worldwide. Low- and middle-income countries continue to experience an increase in stroke incidence despite scientific advances to prevent strokes. In this topical review, we provide an overview of primordial and primary prevention strategies and present actionable practices that may improve access to stroke prevention including policies and population-wide strategies, such as task-shifting and sharing and health system reengineering. Most strokes can be prevented through primordial prevention defined as the avoidance of the emergence of risk factors and primary prevention defined as effective management of risk factors. Primordial and primary stroke prevention strategies are predominantly behavioral (eg, smoking and recreational drug avoidance or cessation, physical activity, healthy diet) and pharmacological (eg, medications that control risk factors such as diabetes, hypertension, or cholesterol). However, access to primordial and primary stroke prevention is variable and affected by multiple social and commercial determinants of the health of individuals as well as the environments in which they live, cultural considerations, and the policies that govern these environments. In light of emerging novel risk factors such as mental stressors, air pollutants, diet types, and risk factors specific to women, additional societal, individual, health care professionals, funders, and health system efforts should be mobilized for equitable and effective implementation of stroke prevention.