Primary prevention of stroke

Abstract

Hypertension is the major risk factor for stroke. In the Hisayama study, the risks of cardiovascular disease increased significantly from the lower range (120–129/80–84 mmHg) of prehypertension in a general Japanese population. Since the clinical trial SPRINT demonstrated that targeting a systolic blood pressure of less than 120mmHg reduced fatal and nonfatal major cardiovascular events, blood pressure goals in patients with hypertension currently tend to be more intensive. However, we should conduct more careful antihypertensive treatment when setting blood pressure target in the elderly or patients with cerebral artery stenosis. The meta–analysis including the majority studies for primary stroke prevention has shown that reducing LDL cholesterol with statins reduces the risk of stroke, therefore statin therapy is recommended for patients with dyslipidemia, especially having diabetes mellitus. Early detection and treatment of atrial fibrillation are valuable prevention for stroke risk reduction in the elderly. Anticoagulation should be considered even for the patients with atrial fibrillation (CHADS2 0 or 1) and other vascular risk factors. Regarding primary prevention of stroke for patients with asymptomatic cerebral atherosclerosis and silent lacunar infarction, intensive management of vascular risk factors such as hypertension and diabetes mellitus is the most important treatment for stroke prevention, and antiplatelet therapy should be taken into considered only in patients with high risk of ischemic stroke.

It is also essential to educate and enlighten the knowledge of stroke risk factors and warning signs to the general public.