Ischemic stroke primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]Maryam Hadipour, M.D.[3]
Overview
Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke.
Primary Prevention
Up to 90% of all strokes are preventable, and attributable to 10 modifiable risk factors. Case-control studies showed that 10 vascular risk factors and concomitant diseases account for 90% of the stroke risk including history of hypertension or blood pressure ≥140/90 mm Hg, lack of regular physical activity, apolipoprotein B/A1 ratio, diet (mAHEI score), Waist-to-hip ratio, Psychosocial factors, current smoking, cardiac causes (AF, MI, RhVD, PVD), alcohol intake, and history of diabetes mellitus or HbA1c ≥ 6.5. Lifestyle modifications including healthy diets, weight loss, termination of smoking, and regular physical activity are recommended as primary prevention for stroke events. Reducing blood pressure in persons with hypertension is highly effective in preventing ischemic stroke; every 10-mm Hg reduction in systolic blood pressure and 5-mm Hg reduction in diastolic blood pressure reduces the risk of stroke by 41%.[1][2]
Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke. Effective measures for primary prevention of stroke include:[3][4][5][6]
- Genetic testing and treatment for diseases with increased risk of ischemic stroke such as Fabry's disease
- Life-style modifications such as increased physical activity in obese or overweight patients to maintain a healthy weight
- Treatment of hypertension, diabetes mellitus and hyperlipidemia[7]
- Treatment of atrial fibrillation and anticoagulant prophylaxis
- Procedures such as carotid endarterectomy or carotid angioplasty can be used to remove significant atherosclerotic narrowing (stenosis) of the carotid artery
- Smoking cessation and decreased alcohol intake
For AHA/ASA guidelines for primary prevention of stroke, click here.
References
- ↑ Ezekowitz JA, Straus SE, Majumdar SR, McAlister FA (December 2003). "Stroke: strategies for primary prevention". Am Fam Physician. 68 (12): 2379–86. PMID 14705756.
- ↑ Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS (July 2021). "2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association". Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check
|pmid=value (help). - ↑ Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD; et al. (2006). "Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 113 (24): e873–923. doi:10.1161/01.STR.0000223048.70103.F1. PMID 16785347.
- ↑ Awada A (2011). "[Primary and secondary prevention of ischemic stroke]". J Med Liban. 59 (4): 213–9. PMID 22746010.
- ↑ Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB (2008). "Primary prevention of stroke by healthy lifestyle". Circulation. 118 (9): 947–54. doi:10.1161/CIRCULATIONAHA.108.781062. PMC 2730914. PMID 18697819.
- ↑ Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G; et al. (2001). "Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association". Stroke. 32 (1): 280–99. PMID 11136952.
- ↑ American Heart Association. (2007). Stroke Risk Factors Americanheart.org. Retrieved on January 22, 2007.