Guidelines for primary Prevention of stroke

Factor	Goal	Recommendations
Hypertension (HTN)   Smoking   Diabetes   Asymptomatic carotid stenosis   Atrial fibrillation Ÿ Age < 65y, no risk factors Ÿ Age < 65y, with risk factors Ÿ Age 65-75y, no risk factors Ÿ Age 65-75y, with risk factors Ÿ Age > 75y, with/without risk factors	SBP < 140 mmHg DBP < 90 mmHg     Cessation   Improved glucose control; treatment of HTN	Measure BP in all adults at least every 2 years. Promote lifestyle modification: weight control, physical activity, moderation of alcohol intake, and moderate sodium intake. If BP > 140/90 mmHg after 3 months of life habit modification or if initial BP > 180/100 mmHg, add antihypertensive medication; individualize therapy to patient’s other requirements and characteristics.   Strongly encourage patient and family to stop smoking. Provide counseling, nicotine replacement, and formal programs as available.   Diet, oral hypoglycemics, insulin.   Endarterectomy may be considered in selected patients with > 60% and < 100% carotid stenosis, performed by surgeon with < 3% morbidity/mortality rates. Careful patient selection guided by comorbid conditions, life expectancy. Patients with asymptomatic stenosis should be fully evaluated for other treatable causes of stroke.     Aspirin   Warfarin (target INR: 2.5; range: 2.0-3.0)   Aspirin or warfarin   Warfarin (target INR: 2.5; range: 2.0-3.0)   Warfarin (target INR: 2.5; range: 2.0-3.0)

GUIDELINES FOR PRIMARY PREVENTION OF STROKE (CONT’D)

Factor	Goal	Recommendations
Lipids Initial evaluation (no CHD) Ÿ TC < 200 mg/dl and HDL >= 35 mg/dl Ÿ TC < 200 mg/dl and HDL < 35 mg/dl Ÿ TC 200-300 mg/dl and HDL >= 35 mg/dl and < 2 CHD risk factors Ÿ TC 200-239 mg/dl and HDL < 35 mg/dl or < 2 CHD risk factors Ÿ TC >= 240 mg/dl   LDL evaluation Ÿ No CHD and < 2 CHD risk factors Ÿ No CHD but >= 2 CHD risk factors Ÿ Definite CHD or other atherosclerotic disease     Physical inactivity     Poor diet/nutrition   Alcohol     Drug abuse	General education   >= 30 minutes of moderate intensity activity daily   Moderation     Cessation	Repeat TC and HDL within 5 yrs or with physical examination Lipoprotein analysis   Dietary modification, reevaluation in 1-2 years   Lipoprotein analysis     Lipoprotein analysis   6-month trial of diet modification. Drug therapy if LDL remains >= 190 mg/dl. 6-month trial of diet modification. Drug therapy if LDL remains >= 160 mg/dl. 6 to 12 week trial of Step II diet (AHA step II diet: < 30% fat, < 7% saturated fat, < 200 mg cholesterol per day). Drug therapy if LDL remains >= 130 mg/dl.   Moderate exercise (e.g., brisk walking, jogging, cycling, or other aerobic activity) Medically supervised programs for high-risk patients (e.g., cardiac disease) and adaptive programs depending on physical/neurologic deficits   Diet containing at least 5 servings of fruits and vegetables per day may reduce risk of stroke.   No more than 2 drinks/day for men and 1 drink/day for nonpregnant women   In-depth history of substance abuse should be included as part of complete health evaluation for all patients

STROKE: RISK FACTORS IN WOMEN

¯ Pregnancy

¯ Oral contraceptive uses

¯ Hormone replacement therapy

¯ Fibromuscular dysplasia

¯ Migraine

¯ Collagen vascular diseases

¯ Mitral valve prolapse

How can subsequent strokes be prevented in patients who have survived a first stroke?

1. Risk factor modification

2. Antiplatelet agents: aspirin, ticlopidine, clopidogrel

3. Anticoagulation: warfarin

4. Carotid endarterectomy

5. Surgical procedure to correct cerebral aneurysm or arteriovenous malformation

Дата добавления: 2015-10-30