scholarly journals Recent advances in preventing stroke recurrence

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1017 ◽  
Author(s):  
J David Spence
Keyword(s):  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Vitamin B12 Deficiency ◽  
Plasma Renin ◽  
Intracranial Stenosis ◽  
Lipid Lowering ◽  
Stroke Recurrence ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Recent Advances

Recent advances in secondary stroke prevention include new evidence in hypertension, nutrition, anticoagulation, antiplatelet therapy, intracranial stenosis, percutaneous closure of patent foramen ovale, and lipid-lowering therapy. Individualized therapy for hypertension based on phenotyping with plasma renin and aldosterone markedly improves blood pressure control in patients with resistant hypertension. A Mediterranean diet can reduce the risk of stroke by nearly half. The diagnosis and treatment of metabolic vitamin B12 deficiency, and B vitamins to lower homocysteine, can reduce the risk of stroke by approximately 30%. There are problems with clopidogrel that can be overcome by using ticagrelor, and new anticoagulant drugs markedly improve anticoagulation for stroke prevention, particularly in atrial fibrillation. There are pharmacokinetic problems with dabigatran that deserve attention. Intensive medical therapy is better than stenting for intracranial stenosis, and new therapies directed at proprotein convertase subtilisin–kexin type 9 (PCSK9) will revolutionize lipid-lowering therapy. In the past, it was estimated that rational therapy could reduce recurrent stroke by about 80%. With recent advances, we should be able to do even better.

scholarly journals Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China

2020 ◽  
Vol 11 ◽  
Author(s):  
Kang-Ning Chen ◽  
Li He ◽  
Lian-Mei Zhong ◽  
Yu-Qin Ran ◽  
Yan Liu
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Blood Lipid ◽  
Lipid Lowering ◽  
Stroke Recurrence ◽  
Lipid Lowering Therapy ◽  
Stroke Patients ◽  
Control Groups ◽  
Lowering Therapy

Background: The benefit of blood cholesterol reduction for secondary prevention of ischemic stroke remains undetermined in Chinese patients. The purpose of this meta-analysis was to determine whether lipid-lowering agents including statins, fibrates, nicotinic acid, and ezetimibe reduced the risk of recurrent stroke in ischemic stroke patients in China and whether such findings could inform treatment decisions for blood lipid-lowering treatment in China.Methods: The English electronic databases PubMed, EMBASE, Cochrane Library and Chinese databases CNKI, Sino-Med, Wan Fang, and VIP were searched for studies published between January 1990 and April 2020. This meta-analysis included published data from trials that randomly assigned patients to groups treated with either blood lipid-lowering regimens or placebo. Effect comparisons were made using fixed effects model in meta-analysis and linear and spline regression were performed to identify the relative risk of stroke recurrence. The primary outcome was the reduction of total ischemic stroke events, and relative risk values were obtained using a risk prediction equation developed from the control groups of the included trials.Results: Five studies including 4,999 individuals with available data met the inclusion criteria. Relative to the control groups, the pooled estimated odds ratio (OR) for recurrent stroke among those who received lipid-lowering therapy was 0.79 (95% confidence interval [CI]: 0.63–1.00). A 50% or greater reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduced the risk of ischemic stroke recurrence (OR: 0.15 [95% CI: 0.11–0.20]). The overall beneficial effect of statin therapy was confirmed to prevent ischemic stroke with an OR of 0.51 (95% CI: 0.36–0.72).Conclusions: Effective lipid-lowering therapy could decrease the blood LDL-C level, which had a protective effect against stroke recurrence. These results support the use of predicted baseline cerebrovascular disease risk equations to inform decisions regarding blood lipid-lowering treatment in ischemic stroke patients in China.

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.

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 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.

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