scholarly journals Stroke Prevention and Sodium Restriction

2008 ◽  
Vol 35 (3) ◽  
pp. 278-279 ◽  
Author(s):  
Norman RC Campbell ◽  
J David Spence
Keyword(s):  
Stroke Prevention ◽  
Task Force ◽  
Population Attributable Risk ◽  
Cost Effective ◽  
Personal Communication ◽  
Pressure Control ◽  
Dominant Strategy ◽  
Lipid Lowering ◽  
Effective Control ◽  
Lipid Lowering Therapy

Stroke prevention is extremely cost-effective. The Ontario Task Force for the Coordinated Stroke Strategy for Ontario received from Dr. Muhammad Mamdani of the Institute for Clinical Evaluative Sciences the estimate that stroke prevention is approximately ten times more cost-effective than treating acute stroke with tPA.1 Hackam and Spence2 have calculated that in the highest-risk patients it would be possible to reduce the risk of stroke by more than 90% by a combination of interventions (including blood pressure control, smoking cessation, diet, treatment of diabetes, lipid-lowering therapy, and for patients in whom it is indicated, anticoagulation for atrial fibrillation or carotid endarterectomy). Dr Mukul Sharma (personal communication) has shown that stroke prevention is a dominant strategy in health economic terms; i.e. that it improves outcomes while reducing net costs. Effective control of hypertension has the potential to reduce stroke by half.3,4 Because hypertension is so prevalent, it accounts for the greatest population attributable risk for stroke, and thus represents the greatest opportunity to reduce stroke.

scholarly journals Stroke Prevention: Little-Known and Neglected Aspects

2021 ◽  
pp. 1-14
Author(s):  
M. Reza Azarpazhooh ◽  
Chrysi Bogiatzi ◽  
J. David Spence
Keyword(s):  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Blood Pressure Reduction ◽  
The Elderly ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Enteric Coating ◽  
Asymptomatic Carotid ◽  
Lowering Therapy ◽  
Direct Acting

Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.

Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy?

2011 ◽  
Vol 19 (3) ◽  
pp. 474-483 ◽  
Author(s):  
R Ara ◽  
A Pandor ◽  
J Stevens ◽  
R Rafia ◽  
SE Ward ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Events ◽  
Cost Effective ◽  
Effective Alternative ◽  
Lipid Lowering ◽  
High Dose ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Cost Effective Alternative ◽  
The Cost

Background: While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients. Methods and results: Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose–response: rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative. Conclusion: Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.

Stroke prevention with lipid-lowering therapy

2004 ◽  
Vol 4 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Bartlomiej Piechowski-Jozwiak ◽  
Julien Bogousslavsky
Keyword(s):  
Stroke Prevention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

scholarly journals RELATIONSHIP OF BRAIN NATRIURETIC PEPTIDE WITH SERUM LIPIDS AND BODY MASS INDEX IN HEALTHY ADULT MALES

2010 ◽  
Vol 17 (02) ◽  
pp. 274-278
Author(s):  
MEH JABEEN ◽  
Shah Murad ◽  
MOHAMMAD FURQAN ◽  
Zulfiqar-ul- Hassan ◽  
MOHSIN TURAB ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Healthy Adult ◽  
Task Force ◽  
Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Adult Males ◽  
Relationship Of ◽  
Apparently Healthy

Prevalence of morbid obesity has increased dramatically world wide during past three decades. BNP a cardiac lipolytic hormone is found to be decreased in obese hypertensive and heart failure patients. Increasing values of BMI are associated with dyslipidemia. Objective: To find out the relationship of BNP with increasing values of BMI and individual serum lipid fractions in apparently healthy adult males. Study Design: Observational, cross-sectional study. Setting: Department of Physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Material & Methods: Study included 85 adult males, aged between 20-60 years. All were nonsmokers, non- diabetic, having no other chronic illness and not taking any lipid lowering therapy. Study participants were evaluated for lipid profile and divided into three groups for the calculated BMI values according to WHO and International Obesity Task Force. Brain NatriureticPeptide was assayed by AxSym technology. Results: Brain Natriuretic Peptide developed a negative correlation with BMI, total and LDLcholesterol and a positive relation with HDL-cholesterol and triglycerides. Conclusions: This study concluded that Brain Natriuretic Peptide is negatively related with increasing values of BMI and degree of dyslipidemia in apparently healthy adult males.

scholarly journals Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization

2019 ◽  
Vol 14 (8) ◽  
pp. 818-825 ◽  
Author(s):  
Michael Brainin ◽  
Valery Feigin ◽  
Philip M Bath ◽  
Epifania Collantes ◽  
Sheila Martins ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Community Health ◽  
Community Health Workers ◽  
Stroke Prevention ◽  
Health Workers ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Prevention Strategy ◽  
Lipid Lowering ◽  
Prevention Strategies

The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs).  This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy.  (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia.  (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs.  (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.

scholarly journals Stroke Prevention in Older Adults

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3770-3777
Author(s):  
J. David Spence ◽  
M. Reza Azarpazhooh ◽  
Susanna C. Larsson ◽  
Chrysi Bogiatzi ◽  
Graeme J. Hankey
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Carotid Stenosis ◽  
Stroke Prevention ◽  
B Vitamins ◽  
Intestinal Microbiome ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Old Patients ◽  
Lowering Therapy

The risks of stroke and dementia increase steeply with age, and both are preventable. At present, the best way to preserve cognitive function is to prevent stroke. Therapeutic nihilism based on age is common and unwarranted. We address recent advances in stroke prevention that could contribute greatly to prevention of stroke and dementia at a time when the aging of the population threatens to markedly increase the incidence of both. Issues discussed: (1) old patients benefit even more from lipid-lowering therapy than do younger patients; (2) patients with stiff arteries are at risk from a target systolic blood pressure <120 mm Hg; (3) the interaction of the intestinal microbiome, age, and renal function has important dietary implications for older adults; (4) anticoagulation with direct-acting oral anticoagulants should be prescribed more to old patients with atrial fibrillation; (5) B vitamins to lower homocysteine prevent stroke; and (6) most old patients in whom intervention is warranted for carotid stenosis would benefit more from endarterectomy than from stenting. An 80-year-old person has much to lose from a stroke and should not have effective therapy withheld on account of age. Lipid-lowering therapy, a more plant-based diet, appropriate anticoagulation or antiplatelet therapy, appropriate blood pressure control, B vitamins to lower homocysteine, and judicious intervention for carotid stenosis could do much to reduce the growing burden of stroke and dementia.

scholarly journals CENTRALISED SURVEY ON THE UNDERTREATMENT OF THE HYPERCHOLESTEROLEMIA IN RUSSIA (CEPHEUS)

2013 ◽  
Vol 12 (4) ◽  
pp. 67-74 ◽  
Author(s):  
S. A. Boytsov ◽  
Yu. V. Khomitskaya
Keyword(s):  
Task Force ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cross Sectional ◽  
Start Date ◽  
Lowering Therapy ◽  
European Task ◽  
Lowering Drug

Aim.To assess the percentage of the patients who receive lipid-lowering drug therapy and achieve target levels of low-density lipoprotein cholesterol (LDL–CH), in accordance with the recommendations by the Russian Cardiology Society (RCS) and the 4th Joint European Task Force (4JETF).Material and methods.The CEPHEUS study is a multi-centre, cross-sectional observational study with the participation of Russian patients. The study participants received lipid-lowering therapy for at least 3 months (no dose modification for ≥6 weeks). The start-date and end-date of the study were Oct 22nd 2010 and Mar 22nd 2011, respectively. The cross-sectional data were collected during a single visit to the clinic.Results.The study included 1000 Russian patients. Overall, target LDL–CH levels were achieved in 34,5% (RCS criteria) and 48,2% (4JEFT criteria) of the patients who received lipid-lowering therapy in the routine clinical practice. The patients who were treated for secondary prevention of cardiovascular events (CVE) achieved target levels of LDL–CH more often than the patients treated for primary prevention: 38,2% vs. 27,0%, respectively, by the RCS criteria (odds ratio (OR) 1,67; 95% confidence interval (CI) 1,22–2,28; p=0,001) and 54,5% vs. 35,4%, respectively, by the 4JEFT criteria (OR 2,19; 95% CI 1,63–2,95; p<0,001).Conclusion.Target levels of LDL–CH are achieved by <50% of the Russian patients who receive lipid-lowering treatment. This percentage is even lower in patients receiving lipid-lowering treatment for primary CVE prevention.

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