Imagine waking up one morning and your life has changed forever. You try to move, but one side of your body won’t respond. You attempt to speak, but the words don’t come out right – or at all. Your vision is blurred, your thoughts are scattered, and your independence is suddenly gone. This is the devastating reality for millions of people each year who experience a stroke.

Stroke is one of the leading causes of death and disability worldwide. Each year, an estimated 11.9 million people suffer a stroke, and for most patients, the consequences are life-threatening. Almost 70-79% of people with stroke are reported to either die or experience serious disability within 5 years of their event.

The ripple effect of Stroke

When a stroke strikes, it is not just the person with stroke who is affected, but also their friends, family and colleagues. As many as 3 in 4 survivors of stroke require assistance from their family and friends with essential activities of daily living, such as eating, grooming, bathing, dressing, and toileting, among others. This can impose a significant burden on the caregiver, resulting in burnout, depression, and reduced workforce participation. In Australia in 2023, the cost of informal caregiving after stroke was estimated to cost >AU$3.9 billion in lost productivity costs.

A looming global issue

With population growth and ageing, and no improvement in current prevention and treatment strategies, a bleak outlook has been predicted for stroke. By 2050, it is estimated that as many as:

• 21.4 million strokes will occur each year
• 159.3 million people will be living with effects of stroke
• 9.7 million deaths will occur due to stroke
• 144.8 million disability‐adjusted life years will be lost due to stroke
• Total costs of stroke will double, rising to as much as US$2.3 trillion

These figures are not just statistics, they represent real people, families, and communities. The scale of the crisis demands a coordinated, global response.

Prevention: A missed opportunity

Almost 90% of all strokes are linked to 10 potentially modifiable risk factors for stroke, including:

• Hypertension – 47.9%
• Physical inactivity – 35.8%
• Unhealthy lipid profile – 26.8%
• Poor diet – 23.2%
• Obesity (waist-to-hip ratio) – 18.6%
• Smoking – 12.4%
• Cardiac causes (e.g., atrial fibrillation) – 9.1%
• Alcohol intake – 5.8%
• Psychosocial stress – 5.8%
• Diabetes mellitus – 3.9%

Concerningly, we are seeing increases in the prevalence of many of these risk factors for stroke at a global level. Particularly, rises in ultra-processed foods, sedentary behaviors, and obesity and diabetes are specific areas for public health concern. Ensuring timely detection, management and treatment of these risk factors (often with guideline-recommended medications) is of critical importance to curtail the looming burden of stroke.

Research spotlight: Addressing the gaps

As a prevention researcher, my research is focused on leveraging data to evaluate how medicine use can be optimized in the population to stop stroke before it strikes. While we have had major breakthroughs in the availability of acute treatments for stroke over the past three decades, far too many strokes are still occurring. Once a person has a stroke, they also remain at a significantly elevated risk of experiencing a future stroke, necessitating more intensive secondary prevention. The combination of medications, diet, and lifestyle changes are estimated to prevent ≈80% of recurrent strokes.

Once a person has a stroke, they also remain at a significantly elevated risk of experiencing a future stroke, necessitating more intensive secondary prevention.

There is high-quality evidence from clinical trials that specific medicines (e.g., blood-pressure lowering, blood thinning, and lipid-lowering) help to prevent both first-ever and recurrent stroke. However, my research has uncovered gaps in prescription, dispensation, and long-term adherence with these medications. We know these stroke prevention medications work, but why are patients not being prescribed, or not taking them long-term?

My research has uncovered significant inequities in the use of stroke prevention medications, influenced by factors such as age, sex, region of birth, and socioeconomic position. These disparities point to the urgent need for targeted public health strategies and improved access to care. I’ve also found that the reasons behind medication non-adherence are complex and multifaceted, ranging from cost and health literacy to systemic barriers within healthcare systems. We know these medications are effective and that greater adherence improves long-term survival. However, the challenge lies in ensuring medicines are prescribed appropriately, accessible to all, and used consistently over the long term.

My research points to the importance of high-quality, coordinated care from general practitioners (GPs) in stroke prevention and recovery. Ensuring frequent and sustained contact with GPs,13 and use of enhanced, multi-disciplinary care plans, can improve medication adherence.  As stroke care becomes increasingly complex, the integration of GPs into a well-connected, team-based care model is essential to improving outcomes and reducing the risk of recurrent stroke.

A global call to action

The World Stroke Organization, Lancet Neurology Commission has called on governments, health ministries, and other stakeholders to apply pragmatic approaches to optimize the prevention and management of stroke. Global collaboration is essential. Without it, the health and economic burden of stroke will continue to rise, with devastating consequences for individuals and societies.

Global collaboration is essential. Without it, the health and economic burden of stroke will continue to rise, with devastating consequences for individuals and societies.

As part of our new international initiative, INSPIRE-STROKE, we are collaborating across 16 countries to leverage big data to better understand where gaps exist in stroke prevention across the globe. This research will provide essential evidence for policy-makers on the areas where we can intervene to make the biggest difference to enhance stroke prevention and health outcomes. 

The impacts of stroke are significant, life-long, and far-reaching in our communities. As the world grapples with rising healthcare costs and ageing populations, stroke prevention must be recognized as a global health priority. The cost of inaction is too high, and the opportunity to save lives and reduce suffering is too great to ignore.