Stroke prevention

Abstract

Stroke is one of the leading causes of death and disability in the Western world and efforts should be made to prevent the occurrence of stroke. Primary preventive measures are influenced by the patient's risk factor profile. A healthy lifestyle should be encouraged. Hypertension as a major risk factor for stroke should be controlled either by lifestyle measures or, if that is unsuccessful, through pharmacological means. The risk of stroke in diabetic patients with hypertension is increased and blood pressure and blood sugar levels should be controlled. Atrial fibrillation increases the risk of stroke and in high-risk patients oral anticoagulation is recommended. Patients suffering from coronary artery disease and high-risk hypertensive patients should be treated with statins. Asymptomatic carotid artery disease increases the risk of stroke. Before surgery is considered, it is important to optimize medical treatment of vascular risk factors. In addition to these measures, secondary prevention of stroke includes the prescription of antiplatelet therapy. Oral anticoagulation should be reserved for cardioembolic strokes. Symptomatic carotid stenosis should be treated by carotid endarterectomy. Stenting should be reserved for patients with contraindications to surgery or in the setting of clinical randomized trials.