Global health: Brazil's blueprint for chronic diseases and stroke management

Stroke is no longer seen as a sudden, isolated event but as a chronic disease deeply connected to long-term conditions like hypertension, diabetes, and obesity. This shift demands new approaches to prevention and care.

This article explores how emerging models such as Brazil's community-based health strategies and advances in genetic testing now make it possible to identify individuals at high risk earlier than ever before, enabling more targeted, effective interventions suitable for adoption on a global scale.

The American Heart Association's reclassification of stroke underscores its persistent effects: 50% of survivors face apathy or depression within a year, while 30% experience reduced autonomy four years post-event. Chronic inflammation from conditions like diabetes accelerates vascular damage, creating a cyclical relationship where stroke exacerbates preexisting diseases and vice versa.

Community Health Workers (CHWs) model

Brazil's Family Health Strategy (FHS) has emerged as a blueprint for stroke prevention in resource-limited settings. Deploying 265,000 community health workers, the program covers 67% of Brazil’s population, prioritizing low-income communities. CHWs conduct monthly household visits, assess stroke risk factors, and use tools like the Stroke Riskometer app to educate communities. Key outcomes include

- 79% increased knowledge of stroke risk factors and 62% adoption of preventive actions among participants.

- A 31% reduction in cerebrovascular mortality linked to proactive hypertension management.

Prof. Sheila Martins, architect of Brazil’s National Stroke Policy, emphasizes: "Integrating CHWs with mobile technology bridges gaps in primary care, especially in regions with limited access to specialists.”

This model's success lies in its dual focus: addressing social determinants (e.g., income, education) while deploying scalable tools like the Stroke Riskometer, validated across 13 countries for reliable risk assessment.

Chronic Diseases and Stroke Risk: A Data-Driven Perspective

Hypertension accounts for 50% of strokes through its role in atherosclerosis, while diabetes doubles the risk by causing endothelial dysfunction.                                                                    

Interestingly, recent World Stroke Organization infographic data highlight an obesity paradox: higher BMI increases initial stroke risk but is associated with better post-stroke survival.

WHO data highlights disparities: low-income countries bear 89% of stroke-related disability, with Brazil's northeast region showing higher incidence than wealthier southern areas.

The country's Promote Trial dual approach combines a polypill (valsartan, amlodipine, rosuvastatin) with the Stroke Riskometer app for low-to-moderate-risk individuals.

Phase III results show that those taking the polypill experienced a 13 mmHg reduction in systolic blood pressure, compared to just 4 mmHg with placebo, and a 38 mg/dL drop in LDL cholesterol, underscoring its role in primary prevention.

Early risk detection can be boosted with genomics-powered tools. BGI Genomics XOME™ Clinical Whole Exome Sequencing identifies genetic predispositions to chronic kidney disease and Alzheimer's—conditions linked to stroke. For example, Xome WES detects APOE4 variants, enabling early interventions decades before symptom onset.

Three key strategies show promise:

1. Lifestyle Modifications: Mediterranean diets reduce stroke risk by 30%.

2. Tech-Driven Screening: Tools like COLOTECT® (stool DNA testing) offer non-invasive cancer screening, critical for stroke prevention via inflammation reduction.

3. Policy Integration: Brazil’s CHW model demonstrates that training non-clinical workers in risk assessment can reduce hospitalizations by 34%.

Stroke prevention demands a mosaic of approaches: community engagement, accessible technology, and precision medicine. Brazil's success with CHWs and mobile tools illustrates how low-cost, high-impact strategies can disrupt the chronic disease-stroke cycle. As Prof. Martins notes, "Proactive health measures today prevent life-altering consequences tomorrow." By scaling such models and integrating genomic insights, we can transform stroke from a silent epidemic into a manageable global health challenge.

About BGI Genomics XOME Whole Exome Sequencing

XOME™ Clinical Whole Exome Sequencing examines the DNA sequence of over 180,000 exons across 22,000 genes, screening for more than 4000 monogenic diseases. It accurately provides a straightforward and cost-effective approach for identifying the genetic variants responsible for a wide range of genetic disorders, thereby assisting clinical diagnosis

About COLOTECT®

COLOTECT® is a non-invasive fecal DNA test developed by BGI Genomics for detecting CRC and precancerous lesions. It uses multiplex methylation-specific PCR (MSP) technology to trace abnormal DNA-methylation biomarkers in CRC from stool samples. COLOTECT® has a sensitivity of 88% for detecting CRC, and a sensitivity of 46% for the early detection of advanced adenomas—both of which outperform conventional fecal tests.

About BGI Genomics

BGI Genomics, headquartered in Shenzhen, China, is the world's leading integrated solutions provider of precision medicine. Our services cover more than 100 countries and regions, involving more than 2,300 medical institutions. In July 2017, as a subsidiary of BGI Group, BGI Genomics (300676.SZ) was officially listed on the Shenzhen Stock Exchange.