Cape Town, South Africa - The growing problem of stroke has been highlighted by new data suggesting that this condition is now the second leading cause of death worldwide (after heart disease) and is projected to be the leading cause of death by 2030.

These statistics were released by the American Stroke Association to mark World Stroke Day on October 26 and the World Stroke Congress being held here this week, at which renewed calls are being made for more effort directed at the treatment and prevention of this devastating condition.

Dr Lee Schwamm (Director of Acute Stroke Services, Massachusetts General Hospital, Boston) commented to heartwire: "Stroke is a manifestation of vascular disease in the brain. With ischemic heart disease as the number-one cause of death in the world and stroke at number two, atherosclerosis is killing the world."

The cause-of-death figures are taken from World Health Organization (WHO) data, which state that of the 58 million total global deaths in 2005, 7.6 million were from ischemic heart disease and 5.7 million were from cerebrovascular disease.

The claim that stroke is the second leading cause of death depends to some extent on how diseases are classified; this figure has been taken from a table in which individual cancers are classified separately, but when all cancers are considered together, there are more cancer deaths than stroke deaths. But the WHO says that it is not appropriate to compare all forms of cancer with stroke, which makes up just one type of vascular disease.

A WHO spokesperson told heartwire that defining the leading causes of death depends on "how the pie is sliced." She explained that the WHO classifies ischemic heart disease and cerebrovascular disease together as the broad disease group of cardiovascular disease, putting the total number of cardiovascular-disease deaths at 17.5 million. Cancer is also categorized as a broad disease group, and all forms of cancer together are believed to have been responsible for the deaths of 7.6 million people in 2005. In terms of the WHO's disease-categorization systems, the broad disease group of all forms of vascular disease should be compared with the broad disease group of all forms of cancer, and it is inappropriate to compare cancer with a subgroup of vascular disease, namely stroke, she added.

The WHO notes that worldwide deaths from cancer are projected to continue rising, with an estimated 9 million people expected to die from cancer in 2015 and 11.4 million in 2030. Cancer Research UK told heartwire that trends in cancer mortality are somewhat of a "split picture worldwide," with cancer deaths increasing in the developing world but falling in the West. The reduction in cancer mortality in the West, despite an aging population, is a real success story and is thought to be to the result of better prevention (particularly reduced tobacco use), increased early detection, and improved treatment.

But no such progress is being made against stroke. Cochair of the current World Stroke Congress, Dr Vladimir Hachinski, told heartwire that stroke deaths are projected to rise from the current 5.7 million to 6.5 million by 2015 and to 7.8 million by 2030. "Stroke deaths are increasing for two main reasons: because the population is aging, and because worldwide there is massive migration into cities, with people adopting unhealthier lifestyles as a result, with worse diet, more stroking, and less exercise," he explained. "Stroke is poised to overtake ischemic heart disease as the number-one killer worldwide, and it has already reached the number-one position as a cause of death in China and is the leading cause of serious disability in the West. It is imperative that we do more in both the prevention and treatment of this condition," he added.

Schwamm agrees. "We have seen a reduction in stroke in prior decades because of improved treatment of hypertension, but this has now plateaued and stroke rates are on the up again," he commented to heartwire. "As stroke incidence doubles with each decade of age, it is inevitable that strokes will increase as the population ages. But there is an important message here: as we age, we need to work even harder to reduce risk factors for stroke. These include smoking, hypertension, atrial fibrillation, diabetes, and dyslipidemia. People also need to recognize that losing weight and exercising are just as important in the prevention of stroke as in the prevention of coronary heart disease," Schwamm added.

Both Hachinski and Schwamm called for more funding for stroke research. Addressing the perception that cancer is a more high-profile disease than stroke, and thus attracting more funding, Hachinski said: "Cancer deserves all its funding, but stroke deserves to be well supported too. Stroke changes your soul. You are not the same person after a stroke."

Schwamm added: "The cancer field is now seeing great progress—they have begun to attack specific targets and in so doing have managed to defeat many life-threatening cancers. We need to move in this direction with stroke research. There are not enough clinical trials in the stroke arena. There are very few in the treatment of stroke, and almost none directed toward improving functional outcomes in survivors of strokes. The key tPA trial in stroke involved just 700 patients, whereas the large MI treatment trials enroll tens of thousands of patients. All the money is in coronary disease and cancer because this is where all the highly remunerated treatments are."

Asked whether funding for stroke research is limited because of the perception that it is almost too difficult to treat, Schwamm said this was a defeatist attitude. "During the 1950s, MI was thought to be a catastrophic event, with nothing to be done about it, but we have broken through that therapeutic nihilism. The same needs to be done for stroke."

Schwamm also called for better education of the public about stroke symptoms and the importance of getting to the hospital quickly. "We do have a treatment for stroke, in the form of tPA. This showed a 12% absolute benefit in the chance of recovery. That is an enormous effect. But you need to get to the hospital fast—within about two hours of symptom onset—to obtain this benefit. We need more education on this for the public. And we need more stroke systems of care, like those set up for MI, so patients with stroke symptoms are fast-tracked for treatment. The message needs to be drummed home to the public—if you have any symptoms of stroke, don't wait around, call for help and get to the hospital. Individuals with risk factors for stroke, such as the elderly with hypertension, need to be aware of this especially. GPs need to play a greater role here."