The curriculum at UK Medical schools with regards to stroke aetiology
This study has confirmed and brought to light an aetiology that is not currently discussed as a significant part of the curriculum at UK medical schools. The fact that there exists significant evidence to support the assertion that cerebrovascular events can be caused by air pollution has not yet filtered into mainstream medical learning.
The strength of this evidence is also compelling, with the strongest causal relationship being exposure less than a day before the clinical presentation of the patient. At present the risk factors of hypertension and atherosclerosis for ischaemic stroke, and congenital berry aneurysms and hypo-coagulable states for haemorrhage stroke form the basis of our teaching.
It is also to interesting to read about the proposed mechanisms for this effect; especially that air pollution can impact the vascular endothelium so directly as well as increase sympathetic vasoconstriction further compounding hypertensive disease. Perhaps environmental pollution works through the same mechanisms as smoking but on a less concentrated scale.
The toxic gases we are taught about in respiratory physiology are featured (sulphur dioxide and carbon monoxide). PM2.5 was shown in this meta analysis to be a significant influence on cerebral haemodynamics, a compound we doubt many junior doctors and trainees are aware of. It seems vital that research that modifies our understanding of existing disease processes is updated and integrated into medical school curriculums so that the doctors of tomorrow can improve their understanding and improve patient care.
Competing interests: No competing interests