Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar.

Hans-Christoph Diener, Graeme J Hankey

Journal: Journal of the American College of Cardiology 2020;75(15):1804-1818

PMID: 32299593

Free Full Text on Elsevier Science View on PubMed

Abstract

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation.

Address: Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany. Electronic address: [email protected].; Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia.

DOI: 10.1016/j.jacc.2019.12.072

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MeSH Terms: Anticoagulants, Arterial Occlusive Diseases, Carotid Stenosis, Cerebral Arteries, Cerebral Hemorrhage, Fibrinolytic Agents, Foramen Ovale, Patent, Humans, Hyperglycemia, Hyperlipidemias, Hypertension, Ischemic Stroke, Life Style, Platelet Aggregation Inhibitors, Primary Prevention, Risk Factors, Secondary Prevention, Stents, Vertebrobasilar Insufficiency, Vitamin B Complex