脳血管障害と予防医療

抄録

Interventions before the onset of cerebrovascular disease in terms of preventive medicine, it is classified into 2 stages. As for zero–level prevention, it is a lifestyle intervention for the entire population. So–called primary prevention is an approach to a group of patients who already have vascular risk factors.

Zero–level prevention : To reduce the occurrence of risk factors for cerebrovascular disease, the goal is to educate the public widely on the impact of risk factors on the development of stroke and cardiovascular disease, and to manage lifestyle habits appropriately. These include salt reduction, smoking cessation, alcohol conservation, and improved nutrition and diet, including increased physical activity, and are tailored to each stage of life in all generations.

Primary prevention : Appropriate management of major risk factors, such as hypertension, diabetes, dyslipidemia, obesity, and atrial fibrillation, to prevent their development. The goal of blood pressure control is set at <130/80 mmHg and a combination of calcium channel blockers, diuretics, angiotensin–converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), are recommended. In diabetic patients, not only proper management of blood glucose, but also strict control of cardiovascular risk factors such as blood pressure and dyslipidemia is important for stroke prevention. In patients with dyslipidemia, LDL–cholesterol should be controlled to <120 mg/dL. On top of diet, HMG–CoA enzyme inhibitors (statins), ezetimibe, proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors are used. For patients with non–valvular atrial fibrillaiton, primary prevention of cardiogenic cerebral embolism is achieved with anticoagulants starting at a CHADS2 score of 1. Prefer DOAC over warfarin. Left atrial appendage closure devices are now also considered in atrial fibrillation patients at high risk of bleeding.