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{{Ischemic stroke}}
{{Ischemic stroke}}


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==Overview==
==Overview==
Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke.
==Primary Prevention==
==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:<ref name="pmid16785347">{{cite journal| author=Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD et al.| title=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. | journal=Circulation | year= 2006 | volume= 113 | issue= 24 | pages= e873-923 | pmid=16785347 | doi=10.1161/01.STR.0000223048.70103.F1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16785347  }} </ref><ref name="pmid22746010">{{cite journal| author=Awada A| title=[Primary and secondary prevention of ischemic stroke]. | journal=J Med Liban | year= 2011 | volume= 59 | issue= 4 | pages= 213-9 | pmid=22746010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22746010  }} </ref><ref name="pmid18697819">{{cite journal| author=Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB| title=Primary prevention of stroke by healthy lifestyle. | journal=Circulation | year= 2008 | volume= 118 | issue= 9 | pages= 947-54 | pmid=18697819 | doi=10.1161/CIRCULATIONAHA.108.781062 | pmc=2730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18697819  }} </ref><ref name="pmid11136952">{{cite journal| author=Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G et al.| title=Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. | journal=Stroke | year= 2001 | volume= 32 | issue= 1 | pages= 280-99 | pmid=11136952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11136952  }} </ref>  
Up to 90% of all strokes are preventable, and attributable to 10 modifiable risk factors. Case-control studies showed that 10 [[vascular]] risk factors and [[concomitant diseases]] account for 90% of the stroke risk including history of [[hypertension]] or blood pressure ≥140/90 mm Hg, lack of regular physical activity, [[apolipoprotein]] B/A1 ratio, diet ([[mAHEI]] score), Waist-to-hip ratio, Psychosocial factors, current smoking, [[cardiac]] causes ([[AF]], [[MI]], [[RhVD]], [[PVD]]), alcohol intake, and history of [[diabetes mellitus]] or HbA1c ≥ 6.5.
*Genetic testing and treatment for diseases with increased risk of ischemic stroke such as Fabry's disease
Lifestyle modifications including healthy diets, weight loss, termination of smoking, and regular physical activity are recommended as primary prevention for stroke events.
*Life style modifications such as increased physical activity in obese or over weight patients to maintain healthy weight
Reducing blood pressure in persons with [[hypertension]] is highly effective in preventing ischemic stroke; every 10-mm Hg reduction in [[systolic blood pressure]] and 5-mm Hg reduction in [[diastolic blood pressure]] reduces the risk of stroke by 41%.<ref name="pmid14705756">{{cite journal |vauthors=Ezekowitz JA, Straus SE, Majumdar SR, McAlister FA |title=Stroke: strategies for primary prevention |journal=Am Fam Physician |volume=68 |issue=12 |pages=2379–86 |date=December 2003 |pmid=14705756 |doi= |url=}}</ref><ref name="pmid34024117">{{cite journal |vauthors=Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS |title=2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association |journal=Stroke |volume=52 |issue=7 |pages=e364–e467 |date=July 2021 |pmid=34024117 |doi=10.1161/STR.0000000000000375 |url=}}</ref>
*Treatment of hypertension, diabetes mellitus and hyperlipidemia<ref name="americanheart risk">American Heart Association. (2007). [http://www.americanheart.org/presenter.jhtml?identifier=4716 Stroke Risk Factors] Americanheart.org. Retrieved on [[January 22]], [[2007]].</ref>
*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<ref name=ASA/AHA-Primary-Prevention-Guid> 2011 AHA/ASA Guidelines for the Primary Prevention of Stroke http://stroke.ahajournals.org/content/42/2/517  Accessed on November 17, 2016</ref>==
===Summary of recommendation===
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Genetic screening of the general population for prevention of a first stroke is not recommended ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''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''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Noninvasive screening for unruptured intracranial aneurysms in patients with >2 first-degree relatives with SAH or intracranial aneurysms might be reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.'''Universal screening for intracranial aneurysms in carriers of mutations for Mendelian disorders associated with [[aneurysm]] is not recommended ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''5.''' Dosing with [[vitamin K antagonists]] on the basis of [[pharmacogenetics]] is not recommended at this time''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Obtaining a family history can be useful to help identify persons who may be at increased risk of stroke ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|}


{|class="wikitable"
Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke. Effective measures for primary prevention of stroke include:<ref name="pmid16785347">{{cite journal| author=Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD et al.| title=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. | journal=Circulation | year= 2006 | volume= 113 | issue= 24 | pages= e873-923 | pmid=16785347 | doi=10.1161/01.STR.0000223048.70103.F1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16785347  }} </ref><ref name="pmid22746010">{{cite journal| author=Awada A| title=[Primary and secondary prevention of ischemic stroke]. | journal=J Med Liban | year= 2011 | volume= 59 | issue= 4 | pages= 213-9 | pmid=22746010 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22746010  }} </ref><ref name="pmid18697819">{{cite journal| author=Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB| title=Primary prevention of stroke by healthy lifestyle. | journal=Circulation | year= 2008 | volume= 118 | issue= 9 | pages= 947-54 | pmid=18697819 | doi=10.1161/CIRCULATIONAHA.108.781062 | pmc=2730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18697819  }} </ref><ref name="pmid11136952">{{cite journal| author=Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G et al.| title=Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. | journal=Stroke | year= 2001 | volume= 32 | issue= 1 | pages= 280-99 | pmid=11136952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11136952  }} </ref>  
|-
*Genetic testing and treatment for diseases with increased risk of ischemic stroke such as [[Fabry's disease]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
*Life-style modifications such as increased physical activity in obese or overweight patients to maintain a healthy weight
|-
*Treatment of [[hypertension]], [[diabetes mellitus]] and [[hyperlipidemia]]<ref name="americanheart risk">American Heart Association. (2007). [http://www.americanheart.org/presenter.jhtml?identifier=4716 Stroke Risk Factors] Americanheart.org. Retrieved on [[January 22]], [[2007]].</ref>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Referral for genetic counseling may be considered for patients with rare genetic causes of stroke ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
*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]]
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
*Smoking cessation and decreased alcohol intake
|-
'''For AHA/ASA guidelines for primary prevention of stroke, click [[AHA/ASA guideline recommendations for prevention of stroke|here]].'''
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Noninvasive screening for unruptured intracranial aneurysms in patients with [[ADPKD]] and >1 relatives with ADPKD and [[SAH]] or intracranial aneurysm may be considered''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Noninvasive screening for unruptured intracranial aneurysms in patients with cervical [[fibromuscular dysplasia]] may be considered''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


==References==
==References==

Latest revision as of 06:07, 30 August 2023

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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]Maryam Hadipour, M.D.[3]

Overview

Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke.

Primary Prevention

Up to 90% of all strokes are preventable, and attributable to 10 modifiable risk factors. Case-control studies showed that 10 vascular risk factors and concomitant diseases account for 90% of the stroke risk including history of hypertension or blood pressure ≥140/90 mm Hg, lack of regular physical activity, apolipoprotein B/A1 ratio, diet (mAHEI score), Waist-to-hip ratio, Psychosocial factors, current smoking, cardiac causes (AF, MI, RhVD, PVD), alcohol intake, and history of diabetes mellitus or HbA1c ≥ 6.5. Lifestyle modifications including healthy diets, weight loss, termination of smoking, and regular physical activity are recommended as primary prevention for stroke events. Reducing blood pressure in persons with hypertension is highly effective in preventing ischemic stroke; every 10-mm Hg reduction in systolic blood pressure and 5-mm Hg reduction in diastolic blood pressure reduces the risk of stroke by 41%.[1][2]

Primary prevention of ischemic stroke is mainly aimed at treatment and modification of risk factors which are directly associated with increased occurrence of ischemic stroke. Effective measures for primary prevention of stroke include:[3][4][5][6]

For AHA/ASA guidelines for primary prevention of stroke, click here.

References

  1. ↑ Ezekowitz JA, Straus SE, Majumdar SR, McAlister FA (December 2003). "Stroke: strategies for primary prevention". Am Fam Physician. 68 (12): 2379–86. PMID 14705756.
  2. ↑ Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS (July 2021). "2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association". Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check |pmid= value (help).
  3. ↑ 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.
  4. ↑ Awada A (2011). "[Primary and secondary prevention of ischemic stroke]". J Med Liban. 59 (4): 213–9. PMID 22746010.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ American Heart Association. (2007). Stroke Risk Factors Americanheart.org. Retrieved on January 22, 2007.


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