Quantifying risk factor associations for the Primary Prevention of Stroke in different population subgroups

中风是全球发病率和死亡率的主要原因。它是英国第四大致死原因，也是导致成人残疾的主要原因，使患痴呆症的几率翻了一番。随着人口老龄化，预计到2035年，英国中风事件的绝对数量以及中风幸存者的残疾人数将增加三分之一。众所周知，某些少数族裔的中风负担也不成比例地大。因此，预防中风具有巨大的公共卫生重要性，有望为医疗和社会保健支出带来可观的节省。中风作为一种结果与心血管健康密切相关。中风的危险因素包括已确定的心血管疾病的生物学、生活方式和心理社会决定因素，以及对心血管疾病的更广泛的社会经济影响。在最新的欧洲卒中行动计划中，通过修改危险因素对卒中进行一级预防已被添加为一个额外的领域--但建议进一步量化这些风险关系。此外，原始预防或预防有害水平的危险因素已被证明是促进和维持大脑健康的有效策略。为此，美国心脏协会开发了一套7项指标-生活简单7(LS7)来跟踪心血管健康状况。这些指标包括吸烟、BMI、体力活动、饮食模式、总胆固醇、血压和空腹血糖；根据选定的界限将其分为较差、中等和理想水平；对成年人和儿童都是如此。它们易于监控、测量和修改。这些指标进一步组合在一起，给出了一个总体心血管健康评分，分为不足、平均和最佳。然而，在预测英国多种族人群中的(致命/非致命)中风事件方面，缺乏数据单独和作为综合衡量标准的有用性和适宜性。这将特别有用，因为目前的欧盟评分系统使用心血管疾病死亡率作为终点，并基于有限数量的可修改风险因素(血压、胆固醇和吸烟)。其他人，如QRISK，没有考虑饮食和体力活动。因此，目前还不存在一个广泛适用的(第一次)考虑多种风险因素的中风风险工具。

Stroke is a major global cause of morbidity and mortality. It is the fourth leading cause of death in the UK and a leading cause of adult disability, doubling the chances of dementia. With an ageing population, it is expected that by 2035, the absolute numbers of stroke events as well as the number of stroke survivors living with a disability in the UK will rise by a third. It is also well known that certain ethnic minorities bear a disproportionately larger burden of stroke. Thus, preventing stroke is of immense public health importance and expected to bring substantial savings for health and social care expenditures.Stroke as an outcome is strongly linked to cardiovascular health. Risk factors of stroke include the established biological, lifestyle and psychosocial determinants of, as well as wider socio-economic influences on, cardiovascular disease. Primary prevention of stroke by risk factor modification has been added as an extra domain in the latest European Stroke Action Plan - but further quantification of these risk relationships is recommended. Additionally, primordial prevention or preventing adverse levels of risk factors to begin with has been shown to be a powerful strategy for promoting and maintaining brain health. To this end, the American Heart Association has developed a collection of 7 metrics - Life's Simple 7 (LS7) to track cardiovascular health. These include smoking, BMI, physical activity, diet patterns, total cholesterol, blood pressure and fasting glucose; categorized into poor, intermediate and ideal levels based on selected cut-offs; for both adults and children. They are easily monitored, measurable and modifiable. The metrics are further combined to give an overall cardiovascular health score categorized as inadequate, average and optimal. However, data is lacking on their usefulness and suitability- individually and as a composite measure- in predicting a (fatal/nonfatal) stroke event in a multi ethnic British population. This would be especially useful since current EU scoring systems for e.g. SCORE, use cardiovascular disease mortality as an endpoint and are based on a limited number of modifiable risk factors (blood pressure, cholesterol and smoking). Others such as QRISK do not take intoaccount diet and physical activity. As such, a widely applicable (first time) stroke risk tool that takes into account multiple risk factors doesn't presently exist.