Editors: Norris JW, Hachinski V
Oxford University Press, 2001
Reviewed by: Dr. Barry Goldlist,
Editor in Chief, Geriatrics & Aging.
The most common cause of death in elderly people is cardiac disease, and arthritis is the most common cause of disability. However, in my experience, elderly patients fear stroke or dementia more than they do either of these, and with good reason. The consequences of stroke are devastating, and evidence from controlled trials of educational interventions in atrial fibrillation suggests that patients are eager to do anything that will reduce their risk of stroke. Yet, in developed countries only about 20% of people with hypertension (the most common risk factor for stroke) have their disorder diagnosed and effectively treated. Similar statistics are seen for other risk factors such as atrial fibrillation. Therefore, there is no doubt that continuing efforts in stroke prevention are required, which is the focus of this superb book.
The two editors are both Canadians, and the contributors come from Canada, Great Britain, the United States, continental Europe, Israel and Australia. The inclusion of a contributor from the World Health Organization ensures that the issue of stroke prevention in developing countries is not ignored.
The text is divided into three parts: Primary Prevention; Secondary Prevention; and Prevention: Policy and Practice. The emphasis is on an evidence-based approach. However, the style of each chapter (presumably the influence of the editors) is quite accessible to all readers because the technical terms are clearly defined. This makes the evidence easier to understand for the reader who is not an expert in critical appraisal, without sounding condescending. The list of references for each chapter is voluminous, and considering the publication delay, surprisingly up-to-date (the chapter on carotid angioplasty and stenting includes a reference from the year 2000). The introduction and epilogue by the editors are superb, the former providing a clear outline of the important information on stroke prevention, and the epilogue outlining difficulties in implementing proven strategies as well as future directions.
This book is a 'must read' for those with a particular interest in stroke prevention, and certainly worth having on the bookcase for reference. I think it is also a very useful text for primary care physicians who see older patients. Its careful presentation of the evidence will allow practising physicians to transmit to their patients the type of information that might convince them to try to prevent stroke. Any physician dealing with older patients would benefit, at a minimum, from reading the prologue and the epilogue to this outstanding text.