Atherosclerotic risk factors in patients with ischemic cerebrovascular disease

Abstract

Aggressive treatment of atherosclerotic risk factors can substantially reduce stroke risk in patients with a history of stroke or transient ischemic attack. Data from several recent large clinical trials provide convincing evidence of benefit for a number of specific therapies directed at this population. The authors recommend treatment with ramipril alone or perindopril plus indapamide regardless of blood pressure, provided there is no contraindication. For patients already taking a different angiotensin- converting enzyme (ACE) inhibitor, the authors do not routinely switch agents. The authors recommend use of simvastatin 40 mg per day in patients with a total cholesterol level of 135 mg/dL or greater, provided no contraindication exists. The authors also recommend consideration of gemfibrozil in patients with isolated low high- density lipoprotein levels. In patients with diabetes mellitus, tight glycemic control has not been shown to reduce macrovascular complications such as stroke, but does reduce microvascular complications. However, diabetics should receive especially aggressive treatment of other vascular risk factors. There is no role for post-menopausal hormone replacement therapy in prevention of stroke. Weight loss for overweight patients, regular exercise, and a diet rich in fruits, vegetables, cereals, and fish, as well as low in fat and cholesterol, should be a standard recommendation for this group of patients. Treatment with folic acid, B(6), and B(12) for patients with elevated homocysteine appears rational, though this is unproven. However, there is no benefit to vitamin E, vitamin C, or beta-carotene supplementation. Smokers should stop. For every 43 smokers who quit, one stroke is prevented. Moderate consumption of alcohol (one to two drinks a day) may be beneficial, but heavy alcohol use (more than five drinks a day) increases stroke risk.

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases

“…4-10 Several factors increase the risk of CSDH recurrence after burr-hole surgery, which include a history of seizure, alcohol abuse, anticoagulant or thrombolytic drugs, and cerebrospinal fluid shunts. 9,[16][17][18][19][20][21] Patients with diabetes and brain atrophy have a higher post-operative recurrence, 21 as well as those with early post-operative mobilisation. 22 We have eliminated these factors in our study by excluding patients predisposed to high recurrence rates.…”

Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model

“…2,4,5,9,15,17,19,20 These factors are frequently associated with brain atrophy, decreased blood homeostasis, and head trauma. In this study, a history of seizure was one independent predictor of recurrence of CSDH; patient age was not found to be a predictor of recurrence.…”

“…5,10 Hyperglycemia is associated with arterial occlusive disease because it induces hyperviscosity of the blood and promotes atherosclerosis. 12 Platelet aggregation 21 and coagulation are activated, 11 and the osmotic pressure of the blood is increased in such a condition.…”