Twenty Years on From the Introduction of the High Risk Strategy for Stroke and Cardiovascular Disease Prevention: A Systematic Scoping Review

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aut.relation.journalEuropean Journal of Neurology
dc.contributor.authorFeigin, Valery
dc.contributor.authorMartins, S
dc.contributor.authorBrainin, M
dc.contributor.authorNorrving, B
dc.contributor.authorKamenova, S
dc.contributor.authorGiniyat, A
dc.contributor.authorKondybayeva, A
dc.contributor.authorAldyngurov, DK
dc.contributor.authorBapayeva, M
dc.contributor.authorZhanuzakov, M
dc.contributor.authorHankey, GJ
dc.date.accessioned2023-12-10T23:07:05Z
dc.date.available2023-12-10T23:07:05Z
dc.date.issued2023
dc.description.abstractBackground and purpose Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. Methods In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. Results No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. Conclusions Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
dc.identifier.citationEuropean Journal of Neurology, ISSN: 1351-5101 (Print); 1351-5101 (Online), Wiley. doi: 10.1111/ene.16157
dc.identifier.doi10.1111/ene.16157
dc.identifier.issn1351-5101
dc.identifier.issn1351-5101
dc.identifier.urihttp://hdl.handle.net/10292/17055
dc.publisherWiley
dc.relation.urihttps://onlinelibrary.wiley.com/doi/10.1111/ene.16157
dc.rights© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subject1103 Clinical Sciences
dc.subject1109 Neurosciences
dc.subjectNeurology & Neurosurgery
dc.subject3202 Clinical sciences
dc.subject3209 Neurosciences
dc.titleTwenty Years on From the Introduction of the High Risk Strategy for Stroke and Cardiovascular Disease Prevention: A Systematic Scoping Review
dc.typeJournal Article
pubs.elements-id530800
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NISAN - the National Institute for Stroke and Applied Neurosciences