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London: Stroke Association, 1996; 247—60 22 Office of Populanon Censuses and Surveys Morbidity stanstics from general prac Insight Global prevention of stroke and dementia: the WSO Declaration The global burden of stroke and dementia are increasing. If current trends continue, by 2050 we can expect about 200 million stroke survivors and 106 million people with dementia, and each year thereafter, over 30 million new strokes, 12 million deaths from stroke, and almost 5 million deaths from dementia. This looming future will threaten the sustainability of health systems worldwide. Yet it is preventable, as a substantial proportion of the burden is attributable to risk factors that can be modified. However, current strategies of primary prevention for stroke and cardiovascular disease to modify causal risk factors have not proved sufficiently effective in containing the rapidly increasing burden of stroke. There is an urgent need to address the limitations of current strategies, and to entertain new, more effective, affordable, and widely applicable strategies to complement current approaches in the fight against stroke and dementia. Given the commonality of risk factors and the reciprocal relationship of stroke and dementia, a joint prevention strategy is recommended. The primary prevention of stroke and dementia is a priority of the World Stroke Organization (WSO). In 2020, the WSO Board of Directors adopted the Declaration for worldwide stroke and dementia prevention (figure), and the concept of prevention entitled the Cut Stroke in Half framework. The WSO recommends that primary stroke and dementia prevention interventions meet the following criteria: (1) sufficient evidence of efficacy, (2) potential population-wide coverage, (3) applicability for both stroke and dementia prevention, and (4) low cost and affordability even in low-income countries. Of the available strategies analysed, only four met all these four criteria. First, a population-wide strategy to reduce exposure to risk factors associated with stroke, dementia, cardiovascular disease, and other risk factors related to non-communicable diseases (including environmental risk factors such as air pollution), across the lifespan, regardless of the degree of cardiovascular disease risk. Second, a motivational population-wide strategy using the free Stroke Riskometer app to reduce lifestyle and other risk factors in adults at any increased risk of stroke development. Third, a polypill strategy (consisting of two generic low-dose blood pressure drugs [eg, losartan 16 mg and amlodipine 2·5 mg] and one generic lipid lowering medication [eg, rosuvastatin calcium 10 mg]) for middle-age and older adults at risk of cardiovascular disease (ie, those with at least two behavioural or metabolic cardiovascular disease risk factors). Fourth, preventative strategies to control behavioural risk factors (especially smoking and high blood pressure) and diabetes via community health workers (community health workers were also suggested to facilitate implementation of strategies 2 and 3). The WSO also recommends abandoning categorisation of people into low, moderate, and high risk for stroke or cardiovascular disease, but rather considering stroke risk as a continuum. Policy makers should prioritise populationwide strategies for the primary prevention of stroke and dementia, cardiovascular disease, and other major non-communicable diseases. These measures should be facilitated by imposing taxation on smoking, sugar, and alcohol to reduce their consumption and promote healthy behaviours, as well as addressing air pollution and societal issues during the life course (eg, socioeconomic disparities, so-called junk-food outlets, inequalities of access to health facilities) known to underpin stroke, dementia, and other non-communicable diseases. Revenues from such taxations can and should be reinvested back into the public health sector to further improve prevention, research, and health care. Current primary stroke and cardiovascular disease prevention strategies emphasise the so-called high-risk approach to prevention, which targets exclusively individuals at high risk of disease. Although this approach can be effective for some individuals, it might not include risk assessments and interventions for some important lifestyle factors (eg, poor diet, physical activity, obesity, alcohol intake) and might be too expensive to