Abstract

INTRODUCTION

Worldwide, stroke is the second most common cause of death and the sixth most common cause of disability (Murray and Lopez 1997). By 2020 it is projected to remain the second most common cause of death but to rise to the fourth most common cause of disability. During the second half of the 20th century death rates due to stroke declined by about half in Western Europe and the USA, even more in Japan (Sarti 2000 et al). However, in Eastern European countries (Levi et al 2002) and China (Chinese Ecological Study 2003), rates have been gradually increasing over the last 20 years. These mortality trends are likely to be related to changes in the known risk factors for stroke, including smoking, blood pressure and diabetes, and they may also reflect changes in cholesterol levels. These trends broadly parallel those of coronary heart disease (Lawlor et al 2003), reminding