Ischemic stroke primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Primary Prevention
Primary prevention of ischemic stroke is mainly aimed at treatment and modifcation of risk factors which are directly associated with increased occurence of ischemic stroke. Effective measures for primary prevention of stroke include:[1][2][3][4]
- Genetic testing and treatment for diseases with increased risk of ischemic stroke such as Fabry's disease
- Life style modifications such as increased physical activity in obese or over weight patients to maintain healthy weight
- Treatment of hypertension, diabetes mellitus and hyperlipidemia[5]
- Treatment of atrial fibrillation and anticoagulant prophylaxis
- Procedures such as carotid endarterectomy or carotid angioplasty can be used to remove significant atherosclerotic narrowing (stenosis) of the carotid artery
- Smoking cessation and decreased alcohal intake
2011 AHA/ASA Guidelines for the Primary Prevention of Stroke[6]
Summary of recommendation
| Class III (Harm) |
| "1. Genetic screening of the general population for prevention of a first stroke is not recommended (Level of Evidence: C)" |
| "2. Screening of patients at risk for myopathy in the setting of statin use is not recommended when considering initiation of statin therapy at this time(Level of Evidence: C)" |
| "3. Noninvasive screening for unruptured intracranial aneurysms in patients with >2 first-degree relatives with SAH or intracranial aneurysms might be reasonable (Level of Evidence: C)" |
| "4.Universal screening for intracranial aneurysms in carriers of mutations for Mendelian disorders associated with aneurysm is not recommended (Level of Evidence: C)" |
| "5. Dosing with vitamin K antagonists on the basis of pharmacogenetics is not recommended at this time(Level of Evidence: C)" |
| Class IIa |
| "1. Obtaining a family history can be useful to help identify persons who may be at increased risk of stroke (Level of Evidence: A)" |
| Class IIb |
| "1. Referral for genetic counseling may be considered for patients with rare genetic causes of stroke (Level of Evidence: C)" |
| "2. Treatment for certain genetic conditions that pre- dispose to stroke (eg, Fabry disease and enzyme replacement therapy) might be reasonable but has not been shown to reduce risk of stroke, and its effectiveness is unknown (Level of Evidence: C)" |
| "3. Noninvasive screening for unruptured intracranial aneurysms in patients with ADPKD and >1 relatives with ADPKD and SAH or intracranial aneurysm may be considered(Level of Evidence: C)" |
| "4. Noninvasive screening for unruptured intracranial aneurysms in patients with cervical fibromuscular dysplasia may be considered(Level of Evidence: C)" |
References
- ↑ Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD; et al. (2006). "Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 113 (24): e873–923. doi:10.1161/01.STR.0000223048.70103.F1. PMID 16785347.
- ↑ Awada A (2011). "[Primary and secondary prevention of ischemic stroke]". J Med Liban. 59 (4): 213–9. PMID 22746010.
- ↑ Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB (2008). "Primary prevention of stroke by healthy lifestyle". Circulation. 118 (9): 947–54. doi:10.1161/CIRCULATIONAHA.108.781062. PMC 2730914. PMID 18697819.
- ↑ Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G; et al. (2001). "Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association". Stroke. 32 (1): 280–99. PMID 11136952.
- ↑ American Heart Association. (2007). Stroke Risk Factors Americanheart.org. Retrieved on January 22, 2007.
- ↑ 2011 AHA/ASA Guidelines for the Primary Prevention of Stroke http://stroke.ahajournals.org/content/42/2/517 Accessed on November 17, 2016