Stroke Prevention: Managing Modifiable Risk Factors

Abstract

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.

Study of Symptoms, Risk Factors and Prescribing Patterns in Cerebral Stroke Patients

“…50% of stroke is preventable by control of modifiable risk factors and lifestyle changes (aerobic exercise to counteract inactivity, weight loss in obesity, glucose control in diabetics, smoking cessation, and diet. 5,14 American Stroke Association (ASA) and the American Heart Association (AHA) have recently published updated guidelines for secondary prevention of stroke. 5,20 Framingham Stroke Risk Profile (FSRP) have been developed, which provides an illustration for patient education that are easy to use in clinical practice.…”

“…5,14 American Stroke Association (ASA) and the American Heart Association (AHA) have recently published updated guidelines for secondary prevention of stroke. 5,20 Framingham Stroke Risk Profile (FSRP) have been developed, which provides an illustration for patient education that are easy to use in clinical practice.…”

Risk Factor Management with Guideline-Based Medications for Prevention of Recurrent Ischemic Stroke: A Retrospective Chart Review

“…10 The recommendation for dyslipidemia therapy in secondary stroke prevention is use of high-intensity statins (HI statins) to decrease low-density lipoprotein cholesterol (LDL-C) blood levels by about 50% with a goal LDL<70 mg/dL. 11 Antithrombotic therapy is indicated in all ischemic strokes, with the selection of therapy dependent on the type of stroke experienced.…”

“…26,27 Gaps in education and health literacy also exist between patients and physicians, which may create a poor environment for addressing patient concerns and decrease adherence to medications. 10 Finally, unlike previous studies, this study was conducted in a smaller community hospital, which may be more representative of "real-life" care experienced by patients in rural settings. Further studies would be necessary to identify the significance of disparities in guidelines versus care received in academic versus community hospital settings, as well as the reasons behind them.…”

“…Studies acknowledge that patients with risk factors for stroke typically do not follow physicians' suggestions regarding lifestyle modifications and adherence to medications for prevention. 10 Achieving a comprehensive patient education and medication management plan post-stroke would likely improve patients' understanding of their disease state, the importance of secondary prevention, and how to manage their risk factors. These tasks could be completed by healthcare professionals such as pharmacists, who are increasingly available in hospital settings to assist in transitions of care, medication reconciliation, and patient education, and who are trained specifically to manage complex medication regimens and improve patient education on medication use.…”