The article is of enormous relevance in emphasising the need to improve strategies to reduce the extremely high socio-health and economic impact of stroke worldwide. Thus, the article positions stroke as one of the main health problems in our society (second cause of death worldwide and the second cause of disability in adults), not only for the patients themselves, but also for their families and society in general. Stroke causes long-term sequelae that imply a significant economic burden of care. The direct (i.e. treatment and rehabilitation) and indirect (taking into account lost productivity) costs of stroke worldwide are estimated at more than $891 billion annually. Stroke is also a leading cause of depression and dementia, which are other common symptoms of non-communicable diseases (NCDs).  

The article makes prognostic forecasts based on estimates of mortality and disability-adjusted life years (DALYs), both productive life and quality of life. These stroke burden forecasts are based on mortality, incidence and prevalence estimates from the GBD [the Global Burden of Disease Study] 2019, assuming that medical procedures and prevention will be the same in 2050 as in 2019.

The paper further highlights that we will have a problem meeting the WHO's Sustainable Development Goal 3.4, which indicates the need to reduce the burden of stroke as part of the overall goal of reducing the burden of noncommunicable diseases by one-third by 2030.  

Worryingly, the absolute number of deaths is expected to increase in low- and middle-income countries (South-East Asia, East Asia and Oceania, Latin America, the Americas and Caribbean, North Africa and the Middle East, South Asia super-regions and sub-Saharan Africa). Multiple factors contribute to the high burden of stroke in low- and middle-income countries, including undetected and uncontrolled hypertension, lack of access to high-quality health services, insufficient care and investment in prevention, air pollution, population growth, unhealthy lifestyles (e.g. poor diet, smoking, sedentary lifestyles, obesity, etc.), and also because there is an increased burden of competing infectious diseases in a situation of limited health resources. 

The number of deaths in people under 60 years of age in 2050 is projected to be approximately the same as in 2020. A decrease in the age-standardised stroke rate per 100,000 person-years is also predicted in both age groups (under and over 60 years), although the reduction is less marked in the under-60s, probably due to the increase in vascular risk factors and unhealthy lifestyle habits in younger people.  

The article makes proposals to improve the situation based on four pillars: surveillance, prevention, acute care and rehabilitation. 
Some of these proposals are very important, of which I would highlight:  

• The need to establish cost-effective surveillance systems to provide accurate epidemiological data on stroke to guide prevention and treatment. Establishment of a framework to monitor and evaluate the burden of stroke (and its risk factors) and stroke services at regional and national level; today in almost no European country there are specific national stroke care registries with the possibility to periodically evaluate quality indicators. This is therefore a need that should be implemented as a priority at governmental level. In Europe, the SAPE (Stroke Action Plan for Europe) initiative is being worked on, with the intention of standardising care and assessing indicators on a regular basis. However, this is a difficult task in the absence of specifically designed and audited national registries.   
• Need to promote interdisciplinary stroke services, training for carers and capacity building for community health. These interdisciplinary services should include not only neurologists, but also specialised nurses, rehabilitators, physiotherapists, social workers and mental health specialists. 
• Need to increase public awareness and action to improve healthy lifestyles and prevent stroke through the use of mobile phones and electronic devices across the population. Encourage digital technologies, such as training and awareness-raising videos and applications. 

It is very important to understand that the agents involved in conditioning changes in the devastating reality of stroke at the global level are not only health care providers but also communities, non-governmental organisations and, especially, policy makers at the governmental level. For example, policies aimed at reducing environmental pollution, which is one of the factors increasingly associated with the incidence of stroke, as well as policies aimed at reducing the consumption of unhealthy products such as sugary drinks and processed products, alcohol and tobacco, among others, must be put in place. Improving socio-economic conditions and reducing poverty, promoting universal health coverage and regular public health campaigns to raise awareness of stroke and associated risk factors are paramount.