Secondary Prevention of Ischemic Stroke

2021 ◽  
pp. 417-421
Author(s):  
Lindsy N. Williams
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Medical Treatment ◽  
Lifestyle Changes ◽  
Diagnostic Evaluation ◽  
Antithrombotic Medication ◽  
Pharmacologic Agents ◽  
Selection Of

After an ischemic stroke is diagnosed, a diagnostic evaluation ensues to determine the mechanism of the stroke and contributing risk factors. The appropriate antithrombotic is selected in accordance with the mechanism of the stroke, and the contributing risk factors are treated with pharmacologic agents and lifestyle changes. This chapter discusses the selection of antithrombotic medication, medical treatment, and lifestyle changes for contributing risk factors.

scholarly journals Stroke Prevention: Managing Modifiable Risk Factors

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Silvia Di Legge ◽  
Giacomo Koch ◽  
Marina Diomedi ◽  
Paolo Stanzione ◽  
Fabrizio Sallustio
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Lifestyle Changes ◽  
Thrombin Inhibitors ◽  
Modifiable Risk Factors ◽  
Vascular Events

Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.

scholarly journals Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

2021 ◽  
Vol 23 (1) ◽  
pp. 51-60
Author(s):  
Yuesong Pan ◽  
Zixiao Li ◽  
Jiejie Li ◽  
Aoming Jin ◽  
Jinxi Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Antihypertensive Agents ◽  
Residual Risk ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

The Role of Cardiac Rehabilitation in Achieving Optimal Treatment

2011 ◽  
Vol 7 (1) ◽  
pp. 62
Author(s):  
Miguel Mendes ◽  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Medical Treatment ◽  
Lifestyle Changes ◽  
Coronary Syndrome ◽  
Secondary Prevention Programme ◽  
Lifestyle Measures ◽  
The Cost

The clinical practice of European cardiologists is directed by the European Society of Cardiology’s guidelines for several clinical entities, in which ‘optimal medical treatment’ (a specific drug regime and lifestyle measures) for each syndrome is defined. The described pharmacotherapy is composed of several drugs, since the clinical research behind the recommendations is conducted using an ‘on top of’ strategy. For example, an asymptomatic patient after an acute coronary syndrome with normal ventricular function and without residual ischaemia has an indication to take at least four types of tablets per day, which is difficult to understand and to follow long term. The cost of the drugs is sometimes beyond the patient’s means, which also contributes to lower compliance. A clinician’s practice is usually very busy, which means it is almost impossible to perform patient education and promote adherence to drug therapy and lifestyle changes. Cardiac rehabilitation, as proved by the Global Secondary Prevention Strategies to Limit Event Recurrence after Myocardial Infarction (GOSPEL) study, may be considered the best available secondary prevention programme, as it educates patients and promotes adherence to the optimal medical treatment to a greater degree than usual care.

To Examine the Effectiveness of a Hospital-Based Nurse-Led Secondary Prevention Clinic

2005 ◽  
Vol 4 (4) ◽  
pp. 308-313 ◽  
Author(s):  
Paula M. Mainie ◽  
Gillian Moore ◽  
John W. Riddell ◽  
A.A. Jennifer Adgey
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Cardiac Event ◽  
Artery Bypass ◽  
Effective Means ◽  
Pilot Project ◽  
Lifestyle Changes ◽  
Prevention Clinic

Modification of cardiovascular risk factors can reduce the incidence of myocardial infarction (MI), effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with known cardiovascular disease. Pharmacological treatments and important lifestyle changes reduce people's risks substantially (by 1/3 to 2/3) and can slow and perhaps reverse progression of established coronary disease. When used appropriately, these interventions are more cost-effective than many other treatments, currently provided by the National Health Service [Department of Health National Service Frameworks: coronary heart disease. Preventing coronary heart disease in high risk patients. 2000. HMSO.] Secondary prevention clinics are effective means by which to ensure targets are achieved and assist primary care in long-term maintenance of lifestyle change and drug optimisation. A 2-year hospital-based pilot project was established at the Royal Hospitals, April 2001–April 2003. The aim of the project was to target patients with coronary heart disease, post-MI and/or coronary artery bypass grafting and/or percutaneous coronary intervention, 6 months following their cardiac event. The plan was to assess patient risk factors and medication a minimum of 6 months following their cardiac event to ascertain if government targets were being achieved; secondly, to examine the effectiveness of a hospital-based nurse-led secondary prevention clinic on modifying risk factors and optimising drug therapies.

Stroke in Young Women

2011 ◽  
Vol 38 (3) ◽  
pp. 404-410 ◽  
Author(s):  
Meredith Salisbury ◽  
Gerald Pfeffer ◽  
Samuel Yip
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Migraine With Aura ◽  
Young Women ◽  
Age Group ◽  
Primary And Secondary Prevention ◽  
Vascular Disorders ◽  
Autoimmune Conditions ◽  
Stroke In Young

In women ages 15-45 years, an additional set of risk factors are important in the pathogenesis of ischemic stroke. Some of these pertain strictly to women, and relate to exogenous hormones and pregnancy. Various other conditions are more common in women, which include migraine with aura, selected vascular disorders and autoimmune conditions. These differences do have implications for management in both the primary and secondary prevention of stroke in this age group.

scholarly journals Smartphone-guided secondary prevention for patients with coronary artery disease

2021 ◽  
Vol 8 ◽  
pp. 205566832199657
Author(s):  
Irina Eckardt ◽  
Clara Buschhaus ◽  
Georg Nickenig ◽  
Felix Jansen
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Lifestyle Changes ◽  
Secondary Outcome ◽  
Daily Routine ◽  
Artery Disease

Introduction Coronary artery disease (CAD) is the leading cause of death worldwide. Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD patients follow the corresponding guideline recommendations. The widespread adoption of smartphones offers the opportunity to integrate secondary prevention into the daily routine of CAD patients. Methods We developed an app to integrate secondary prevention into CAD patients’ everyday life (smartphone-guided secondary prevention, SGSP). The app provided a daily 15-minute program that included video-guided exercises, video sessions with background information about CAD, and a tool to record blood pressure and heart rate once a day. The SGSP app was tested with the primary outcome of 28-day adherence. The secondary outcome was a composite of (1) self-reported behavioral changes, (2) gain of knowledge about cardiovascular risk factors, and (3) an increase in quality of life. Results Of the 66 patients screened, 43 (65%) were included into the study and, of those, 17 (40%) used the app continuously for 28 days. From this group, 14 (82%) were physically more active and ten (59%) improved their dietary habits. Usage of the SGSP app was also associated with a gain of knowledge about cardiovascular risk factors (70% physical activity, 59% healthy diet). Conclusion The regular use of a SGSP app appears to support lifestyle changes in patients with CAD.

scholarly journals Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts’ opinion

2020 ◽  
Vol 78 (7) ◽  
pp. 390-396 ◽  
Author(s):  
João Brainer Clares de ANDRADE ◽  
Jay Preston MOHR ◽  
Fabricio Oliveira LIMA ◽  
Levi Coelho Maia BARROS ◽  
Camila Rodrigues NEPOMUCENO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Common Complication ◽  
Review Of The Literature ◽  
Standard Questionnaire ◽  
Poor Outcomes ◽  
Antithrombotic Medication ◽  
E Mail

ABSTRACT Background: Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. Objective: To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. Methods: We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. Results: The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. Conclusion: Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT.

Smartphone app-guided secondary prevention in patients with coronary heart disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Eckardt ◽  
C Buschhaus ◽  
G Nickenig ◽  
F Jansen
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Dietary Habits ◽  
Lifestyle Changes ◽  
Background Information ◽  
Secondary Outcome ◽  
Daily Routine

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Deutsche Forschungsgemeinschaft Background  Coronary artery disease (CAD) is the leading cause of death worldwide. Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD patients follow the corresponding guideline recommendations. The widespread adoption of smartphones offers the opportunity to integrate secondary prevention into the daily routine of CAD patients. Purpose  The purpose of this study was to show that smartphone-guided secondary prevention (SGSP) could achieve lifestyle changes and a gain of disease specific knowledge among CAD patients.  Methods  We developed an app to integrate secondary prevention into CAD patients’ everyday life. The app provided a daily 15-minute program that included video-guided exercises, video sessions with background information about CAD, and a tool to record blood pressure and heart rate once a day. The SGSP app was tested with the primary outcome of 28-day adherence. The secondary outcome was a composite of self-reported behavioural changes, gain of knowledge about cardiovascular risk factors and an increase in quality of life. Results  Of the 66 patients screened, 43 (65%) were included into the study and, of those, 17 (40%) used the app continuously for 28 days. From this group, 14 (82%) were physically more active and ten (59%) improved their dietary habits. Usage of the SGSP app was also associated with a gain of knowledge about cardiovascular risk factors (70% physical activity, 59% healthy diet). Conclusion  The regular use of a SGSP app appears to support lifestyle changes in patients with CAD. Primary and secondary endpoints Results Overall(n = 17) P-Value Adherence (28 days) 17 (39.5) 0.34 Behavioural change Significantly increased physical activity no. (%) 14 (82.4) 0.08 Implemented a healthier diet no. (%) 10 (58.8) 0.64 Relevant gain of knowledge about CVRF Physical activity no. (%) 12 (70.6) 0.13 Unhealthy diet no. (%) 10 (58.8) 1.00 Smoking no. (%) 1 (5.9) 0.47 Stress no. (%) 7 (41.2) 0.13 Potential for long-term use Willingness to use the App over a long time period (>28 days), no. (%) 15 (88.2) 1.00 Abstract Figure.

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