Vladimir Hachinski

Background and purpose The declining incidence of stroke, ischaemic heart disease (IHD) and dementia (the ‘triple threat’) in Norway encourages further investigation. The risks and trends of the three conditions were analysed using data from the Global Burden of Disease study. Methods Global Burden of Disease 2019 estimations were used for age‐, sex‐ and risk‐factor‐specific incidence and prevalence of the ‘triple threat’, their risk‐factor‐attributed deaths and disability combined, their age‐standardized rates per 100,000 population in 2019 and their changes during 1990–2019. Data are presented as means and 95% uncertainty intervals. Results In 2019, 71.1 thousand Norwegians were living with dementia, 157.2 thousand with IHD and 95.2 thousand with stroke. In 2019, there were 9.9 thousand (8.5 to 11.3) new cases of dementia (35.0% increase since 1990), 17.0 thousand (14.6 to 19.6) with IHD (3.6% decrease) and 8.0 thousand (7.0 to 9.1) with stroke (12.9% decrease) in Norway. During 1990–2019, their age‐standardized incidence rates decreased significantly—dementia by −5.4% (−8.4% to −3.2%), IHD by −30.0% (−31.4% to −28.6%) and stroke by −35.3% (−38.3% to −32.2%). There were significant declines in the attributable risks to both environmental and behavioural factors in Norway, but contradictory trends for metabolic risk factors during 1990–2019. Conclusions The risk of the ‘triple threat’ conditions is declining in Norway, despite the increased prevalence. This offers the opportunity to find out why and how and to accelerate their joint prevention through new approaches and the promotion of the National Brain Health Strategy.