Stroke screening has no real effect

25 Aug, 2020
Stroke screening has no real effect
Professor Valery Feigin

Professor Valery Feigin says a radical change in stroke prevention and treatment is needed in the current global health and economic crisis.

The World Stroke Organisation (WSO) and World Heart Federation (WHF) have declared that current screening of Cardiovascular Disease (CVD) risk factors has no significant effect on the incidence and mortality of stroke and ischaemic heart disease.

In a joint statement published in The Lancet, the two leading NGOs called for governments to move away from the widely adopted approach of screening individuals at high-risk of CVD, towards investment in primary prevention at population level.

This would see governments prioritise tobacco and alcohol control measures, as well as the reduction of salt and trans fats in processed foods, and address sedentary lifestyles.

“When 80 percent of strokes happen to people who are not categorised as high-risk, we clearly need to rethink our approach.” says Professor Valery Feigin, Director of the National Institute for Stroke and Applied Neurosciences (NISAN) at Auckland University of Technology (AUT).

“Labelling people as low-risk provides false reassurance and reduces their motivation to control their risk factors, including behaviour risk factors like poor diet, physical inactivity, smoking and alcohol use,” he says.

The adult lifetime risk of stroke is now one-in-four, compared to one-in-six less than two decades ago.

WSO President, Professor Michael Brainin, says: “Global progress on prevention has stalled at an enormous cost to individuals and an increasing cost to society. This failure has been made more visible by the current global health and economic crisis, where poor population health and fragile healthcare systems have combined with COVID-19 to deliver a perfect storm”.

Professor Feigin, who serves on the WSO Executive Committee, says there is ‘scant’ robust scientific evidence that current national screening programmes offer value for money in terms of reducing the burden of disease.

“By focusing all of our efforts on identifying and treating diseases of the circulatory system, we are missing the opportunity to intervene on their shared causes much earlier, when the costs are lowest,” he says.

The estimated benefit-cost ratio would be $10.90 in economic and social returns for every $1.00 spent on population-wide primary prevention, according to The Lancet Taskforce on Non-Communicable Diseases (NCDs).

Professor Feigin says the results would be evident within a year or two – most certainly within an election cycle. He maintains that the annual number of new strokes in New Zealand could be halved, from more than 8,000 to 4,000.

“The benefits of population-wide primary prevention go beyond stroke and ischaemic heart disease – there would be positive flow-on effects for a range of NCDs, including diabetes and most cancers,” he says.

“In the past 30 years, the number of stroke survivors has tripled, yet budgets for stroke-related services remain largely static. The current approach to stroke prevention and treatment is unsustainable, and governments must take radical action now.”