Secondary
Stroke
Prevention
Stroke is the leading cause of disability
In the USA and a major cause of mortality
World wide .
One out of four stroke is recurrent.
Secondary Stroke prevention starts
With deciphering the most likely stroke
Mechanism .
One of the main goals
In stroke reduction is to
control vascular risk
Factors such as Hypertension ,Diabetes
Dyslipidemia and smoking cessation
Changes in lifestyle like a healthy diet
And aerobic exercise are also recommended
Strategies.
Stroke Def
: Stroke is defined as clinical
, Radiological or pathological evidence
Of ischaemia or hemorrhage , involving a
Defined cerebral vascular territory.
In the USA there are approximately
800000 strokes per year.Approximately
600000oof which are recurrent events.
Stroke is now the fifth leading cause of
Death but it remains the number one
Cause if disability in USA .
Once a stroke has occurred treatment
Options are limited and only available for
A short time immediately after the symptom
Onset.As. a result ,stroke prevention has been
Considered the main stay in stroke management
For over half century .
Hypertension: Targeting hypertension
Carries the highest benefit in stroke burden
On population level .
American Heart Association guidelines
Recommend blood pressure goals of less
than140mm Hg systolic and diastolic ,
90mmHg. However there is evidence that
Benefit of lowering Blood pressure extends
To level far below this cut off.
Treatment should not be reserved for only
Those with history of hypertension.
Diabetes :
Is one of the most important vascular risk
Factors for stroke and high yield target
for preventive measures .Among patients
With diabetes the risk of vascular events
is increased thrice compared to non
diabetics ,and in combinations with
Other risk factors the risk increases
Exponentially compared to Individuals
With those risk factors without diabetes.
Intensive glycemic control defined as
Glycated hemoglobin less than 7% was not
Associated with significant reduction in
The rates of stroke (fatal or non fatal)
Among patients with diabetes .
Glycated hemoglobin less than 7% showed
The reduction of 16 % in combined vascular
Outcome.
Life style modifications :
Apart from pharmacology therapy ,
Lifestyle modification,including healthy
Diet regular physical activity ,and weight
Loss in over weight of obese patients
,may have substantial benefits on blood
Pressure and lipid levels and ultimately
Stroke recurrence.
Mediterranean diet was shown to
Protect against cardiovascular disease
and specifically stroke ,decreasing 5years
Stroke risk by approximately by 30%.
In general a diet that encourages a high
Intake of plant based diet nutrients low
Salt intake ,and a limited intake of
saturated fats and simple sugars is
likely to have significant cardiovascular
Benefits if adhere to for long period of time.
Tobacco use should be strongly
discouraged and among smokers smoking cessation leads to a significant reduction
In stroke risk.
Hyperlipidemia :
General Target in secondary stroke
Reduction .
Stroke Prevention by Aggresive Reduction
in Cholesterol Levels ,( SPARCL)
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