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(Stroke. 2002;33:1.)
© 2002 American Heart Association, Inc.

Editorials

Stroke: The Next 30 Years

Vladimir Hachinski, MD, DSc, Editor-in-Chief

From the University of Western Ontario, London, Ontario, Canada.

Correspondence to Dr Vladimir Hachinski, University of Western Ontario, University Hospital, 339 Windermere Rd, PO Box 5339, London, Ontario, Canada N6A 5A5.

The only safe prediction about stroke in the next three decades is that it will be very different. Progress largely depends on discovery, and discovery cannot be predicted. However, understanding from where we are coming may help guide where we are going. Each of the previous editors of Stroke has given his view of stroke and the journal during his tenure, providing a concise and unique chronicle of our field by those who helped shape it.^1–5 Several trends will likely affect the field and the journal.

The Field

The Growing Burden of Stroke
Stroke is the second-leading cause of death in the world⁶ and rising. In the developed world, the proportion of the population over the age of 65 years is growing. In the developing world, where most strokes occur, the population over 60 will double in the next 2 decades.⁷ These trends portend sharp increases in stroke incidence. The shift from traditional, rural ways of life to urbanization and Westernization often means less exercise, more calories, and bad habits, such as smoking. If we are serious about prevention, much can be done to lessen this burden.⁸

The Changing Pathophysiology of Stroke
Most attention has been paid to extracranial disease. However, in the developing world and in American minorities, intracranial disease prevails, about which we know little. Moreover, imaging has unveiled the common occurrence of leukoaraiosis and of "silent" infarcts, both of which can be associated with cognitive decline. Increasingly we are becoming aware of not only large strokes that cripple the body, but little strokes that undermine the mind. Cerebral vascular . . . [Full Text of this Article]

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