Does The Treatment Of Stroke Risk Factors Reduce The Incidence Of Stroke?

1981 ◽  
Author(s):  
John P Conomy
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Arterial Hypertension ◽  
Effective Treatment ◽  
Clinical Studies ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Medical Intervention ◽  
Risk Factor Modification ◽  
Atherosclerotic Process

The answer to the question posed in this title is “yes”, but affirmation is highly qualified. (1) Stroke is not a homogeneous clinical disease state but a dynamic process whose etiologies are manifold. Its causes vary from the commonplace atherothrombotic occlusion of brain arteries and emboli of cardiac origin to rare and complex precipitants. (2) Stroke is not a hemogenous pathologic state. Parenchymal hemorrhage, hemorrhagic infarctions and bland infarctions are very different forms of brain destruction with differing outcomes. The great triumvirate of risk factors in stroke are advanced age, arterial hypertension and heart disease. All of these conditions tend to coexist with the process of atherosclerosis. Hypertension and cardiac disease are potentially amenable to early diagnosis and treatment. In clinical studies, the effective treatment of arterial hypertension is emerging as the clearest evidence that risk factor modification is correllated with a decline in stroke. Therapy for some cardiac diseases constitutes effective stroke prevention as well. Other less direct risk factors for stroke tend to parallel the severity and extent of the atherosclerotic process. These include diabetes mellitus, hyperlipidemias and obesity. Therapeutic modification of these factors has debatable influence on the incidence of stroke and may reflect the atherosclerotic process to medical intervention. Some clinical studies have suggested that certain antiplatelet agents postpone stroke and limit TIAs, at least in males. Anticoagulants may prevent TIAs but do not appear to prevent stroke. Surgery has a definable range of risks and clearly demonstrated benefits in properly selected patients in whom it may relieve TIAs and postpone a given stroke. Surgery does not alleviate an individual patient’s overall stroke risk. The process of stroke prevention will remain imperfect until therapies for hypertension and heart disease are accompanied by more effective treatment of atherosclerosis.

Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Darren T Larsen ◽  
Helmi L Lutsep
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Retention Rates ◽  
Matched Cohort ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

Abstract 14610: Renal Dysfunction in Adults With Congenital Heart Disease in Vietnam

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ngoc Thanh Kim ◽  
Thanh Tung Le ◽  
Doan Loi Do ◽  
Thanh Huong Truong
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Renal Dysfunction ◽  
Congenital Heart ◽  
Pulmonary Arterial

Introduction: In Vietnam, knowledge about renal function in adults with congenital heart disease (CHD) is limited. Hypothesis: This study aims to estimate incidence of renal dysfunction in adults with congenital heart disease and risk factors. Methods: This is a cross-sectional study, including 365 CHD patients more than 16 years old. We collected clinical and para-clinical information, estimated glomerular filtration rate (GFR) and calculated the odds ratio (OR) for reduced GFR. Results: Totally, 52.8% patients had GFR < 90 ml/phút/1.73 m 2 . Logistic regression had confirmed the OR for GFR < 90 ml/phút/1.73 m 2 in the group > 60-years-old, the group with atrial fibrillation, the group with heart failure (based on NT-proBNP > 125 pmol/L), and the group with pulmonary arterial hypertension (based on pulmonary artery systolic pressure > 50 mmHg by echocardiography) were 6.46 (95% CI: 1.37 - 30.41), 7.58 (95% CI: 1.66 - 34.56), 2.98 (95% CI: 1.49 - 5.98) and 1.84 (95% CI: 1.02 - 3.33), respectively. Conclusions: Renal dysfunction is common in adults with CHD. Age > 60 years-old, atrial fibrillation, heart failure, and pulmonary arterial hypertension were risk factors for renal dysfunction in adults with CHD.

Advances in Atrial Fibrillation-related Stroke Prevention

2015 ◽  
Vol 9 (2) ◽  
pp. 122
Author(s):  
Pierre Amarenco ◽  
Werner Hacke ◽  
Bo Norrving ◽  
Natalia Rost ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Haemorrhagic Stroke ◽  
Bleeding Events ◽  
Patients At Risk

In patients with atrial fibrillation (AF) the risk of stroke is substantially increased, especially in those who are elderly (over 75 years) or have risk factors such as previous stroke, heart failure or hypertension. Stroke outcomes are also generally much worse in those with AF. Current guidelines indicate that any patient with AF and risk factors for stroke should receive anticoagulant therapy to limit their stroke risk. Despite these established recommendations, only 50 % of patients at risk receive anticoagulation with a vitamin K antagonist (VKA) and only 50 % of those are within the therapeutic range, indicating lack of adherence to the guidelines. Withholding anticoagulant therapy is mainly left to an individual physician’s choice, as shown in the ongoing GARFIELD registry of AF stroke prevention practice. Many physicians fear the risk of intracranial haemorrhage (ICH) for which outcomes remain poor. Recent clinical studies have shown that the non-VKA oral anticoagulants (NOACs) (apixaban, rivaroxaban, dabigatran and edoxaban) significantly reduce the risk of ICH and other bleeding events, while having non-inferior stroke prevention to warfarin. Use of these drugs, limiting exposure to aspirin and alcohol and controlling blood pressure have been shown to minimise ICH risk in large clinical trials and meta-analyses. Recent data from the Effective aNticoaGulation with factor xA next GEneration in Atrial Fibrillation (ENGAGE AF)-TIMI 48 study showed that the factor Xa inhibitor edoxaban was non-inferior to well-managed warfarin for reducing all stroke risk, and significantly reduced haemorrhagic stroke, major bleeding, ICH and death. These findings further support the case for using NOAC therapy for stroke prevention in patients with AF and risk factors for stroke.

scholarly journals A modern view of the place of b-blockers in the treatmentof cardiovascular disease: the choice of drug within a class is crucial

2015 ◽  
Vol 12 (4) ◽  
pp. 69-74
Author(s):  
O D Ostroumova ◽  
V M Fomina ◽  
E A Smolyarchuk
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Chronic Heart Failure ◽  
Arterial Hypertension ◽  
Clinical Studies ◽  
Metoprolol Succinate ◽  
Selection Of

In the article discusses questions of application of b-blockers (b-AB) for the treatment of arterial hypertension, coronary heart disease, chronic heart failure. The data from modern Russian and European recommendations about the place of b-AB in the treatment of cardiovascular diseases. Analyzed in detail the selection of b-AB inside the class from the standpoint of pharmacokinetics, selectivity, study in clinical studies. Data about efficiency and safety of application of metoprolol succinate for the treatment of arterial hypertension, coronary heart disease, chronic heart failure.

scholarly journals Arterial hypertension and coronary heart disease: the place of angiotensin II receptor antagonists

2012 ◽  
Vol 11 (6) ◽  
pp. 78-80
Author(s):  
E. O. Taratukhin
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Angiotensin Ii ◽  
Arterial Hypertension ◽  
Effective Treatment ◽  
Angiotensin Ii Receptor ◽  
Angiotensin Ii Receptor Antagonists ◽  
Receptor Antagonists ◽  
Pathogenetic Mechanisms

The paper considers arterial hypertension and coronary heart disease as pathologies which share multiple pathogenetic mechanisms. The role of angiotensin II receptor antagonists (ARA) in the effective treatment of these diseases and in prevention of their complications is discussed. The modern views on ARA and their indications are presented.

scholarly journals Generalized data of criteria of risk factors for the use of the drug torasemide from the materials of its preclinical studies

2020 ◽  
Author(s):  
Natalia A. Anisimova ◽  
Natalia O. Selizarova ◽  
Grigory A. Plisko ◽  
Evgeny D. Semivelichenko ◽  
Svetlana M. Napalkova
Keyword(s):  
Risk Factors ◽  
Arterial Hypertension ◽  
Clinical Studies ◽  
Generic Drugs ◽  
Preclinical Studies ◽  
Efficacy And Safety ◽  
Cardiovascular Pathology ◽  
Pharmacological Studies ◽  
Search For Information ◽  
Preclinical And Clinical Studies

This study presents the review and analysis of materials, the summary of the data on the results of experimental (preclinical) pharmacological studies of the drug Torasemide and the results of clinical studies of the original drug Demadex, based on risk factors influencing the outcomes of hypertension in people. The information on the efficacy and safety of the drugs based on Torasemide is also presented in the relevant sections of the article. The search for information sources for the review was carried out using domestic and international databases elibrary and PubMed, applying contextual queries, including international non-proprietary names, terms of preclinical studies of pharmacokinetics, pharmacodynamics, and animal species used. This review considers the aspects of safety, pharmacokinetics, primary and secondary pharmacodynamics of Torasemide, available in various sources describing its preclinical studies. The summarized data presented in the study, in our opinion, may be used by researchers who are engaged in preclinical and clinical studies, as well as the issues of studying the efficacy and safety of generic drugs used in the treatment of patients with arterial hypertension and other cardiovascular pathology. The information on the advantages of Torasemide in comparison with Furosemide in the treatment of animals with simulated arterial hypertension deserves special consideration.

Analysis of risk factors for coronary heart disease

2020 ◽  
pp. 43-47
Author(s):  
Elvina Mukharamovna Nagimova ◽  
Yaroslav Grigorievich Mazin ◽  
Chingiskhan Daudavich Merzhoev ◽  
Emil Rushanovich Badamshin ◽  
Marina Yuryevna Pavlova
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Arterial Hypertension ◽  
Significant Risk ◽  
Circulatory System ◽  
Common Diseases ◽  
Chd Risk ◽  
Chd Risk Factors

At the present time the most common diseases are diseases of the circulatory system, among which the leading place belongs to coronary heart disease (CHD). Risk factors for CHD were studied and evaluated. It was found that in women the most significant risk factors are arterial hypertension (54.5 %), hypodynamia (54.5 %) and stress (41.9 %), and in men — stress (58.1 %), arterial hypertension (40.7 %) and smoking (37.0 %).

A Pharmacist-Led Stroke Education and Screening Program for Community-Dwelling Older Adults

2019 ◽  
Vol 34 (2) ◽  
pp. 127-142
Author(s):  
Marketa Marvanova ◽  
Paul Jacob Henkel
Keyword(s):  
Risk Factors ◽  
Health Status ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Community Dwelling ◽  
Warning Signs ◽  
Secondary Stroke Prevention ◽  
Stroke Risk Factors ◽  
Stroke Knowledge ◽  
Study Questionnaire

OBJECTIVES: To deliver a pharmacist-led education and screening for community-dwelling residents, assess the effect of this initiative on knowledge of stroke risk factors and warning signs, and evaluate the stroke-knowledge and risk-assessment questionnaire as a tool to identify stroke-related health status and identify need(s) for specific clinical intervention(s) to decrease risk.<br/> DESIGN: The 70-minute-long event comprised: brief introduction/informed consent, baseline assessment of stroke knowledge, completion of study questionnaire, single blood pressure and heart rate readings, presentation, question-and-answer session, postsurvey questionnaire items.<br/> SETTING: Four faith-based institutions in the Midwest.<br/> PARTICIPANTS: Independent community-dwelling adults 18 years of age and older (N = 97), 89.7% 60 years of age and older.<br/> INTERVENTIONS: Thirty-minute presentation followed by question-and-answer session on ischemic stroke. Screening for primary and secondary stroke-prevention status using study questionnaire and vital signs.<br/> MAIN OUTCOME MEASURE(S): Stroke knowledge regarding modifiable stroke-risk factors and acute stroke-warning signs, individual primary/secondary stroke-prevention status.<br/> RESULTS: Postintervention, mean number of modifiable stroke risk factors (2.6 ± 0.8) and warning signs (2.6 ± 0.8) named improved from preintervention (P < 0.001) including for most subgroups (i.e., self-reported hypertension, atrial fibrillation [AF], or high number of personal risk factors). Needs for improved primary/secondary prevention were identified for blood-measure control and antilipidemic therapy. No disparity was observed regarding thrombotic therapy in participants with AF.<br/> CONCLUSION: The program was resource-efficient, involved student pharmacists, improved immediate stroke-related knowledge of participants including those with increased risk(s) of stroke, and demonstrated value for evaluating stroke-related health status and identifying need for primary and secondary stroke prevention.

Stroke risk factors and risk stratification in atrial fibrillation

ESC CardioMed ◽  
2018 ◽  
pp. 2182-2185
Author(s):  
Gregory Y. H. Lip
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Decision Making ◽  
Risk Stratification ◽  
Vitamin K ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Vitamin K Antagonist ◽  
Low Risk ◽  
Good Time

Atrial fibrillation increases the risk of stroke, and the more common and validated risk factors have been used to formulate stroke risk stratification schemes, but the default position is to offer stroke prevention to all patients with atrial fibrillation unless they are shown to be at low risk. The use of the CHA2DS2-VASc score is recommended for stroke risk stratification in guidelines. Decision-making for stroke prevention should apply the simple ‘atrial fibrillation three-step’ patient pathway. Step 1 is to initially identify ‘low-risk’ patients (CHA2DS2-VASc 0 in males, 1 in females) who do not need antithrombotic therapy; step 2 is to offer stroke prevention (i.e. oral anticoagulation) to those with at least one stroke risk factor; step 3 is to decide between a vitamin K antagonist (with good time in therapeutic range at >70%) or a non-vitamin K antagonist oral anticoagulant, using the SAMe-TT2R2 score. This simple streamlined practical approach will help risk stratification and treatment decision-making.

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