Primary Prevention10

Preventing a first stroke by looking at its modifiable factors:

• Hypertension control is one of the largest modifiable factors as high blood pressure leads to weaker arteries which can cause clots

  • Lifestyle changes such as lower salt diets, regular exercise can be used

  • Medications can also help such as ACE inhibitors, thiazide diuretics, or angiotensin receptor blockers11

• High cholesterol

  • Lower cholesterol diets can help reduce risk of stroke

  • Medications like statins can lower LDL cholesterol

• Diabetes management

  • Reduces both micro- and macrovascular complications which can lead to stroke

• Stopping smoking

  • Can decrease vessel endothelial wall damage and thrombosis risk

General Lifestyle Changes:

• Regular aerobic exercise

• Healthy diet

• Reduced alcohol intake

Secondary Prevention10

Preventing another stroke after the first event or mini-stroke (transient ischemic attack):

• Medical therapies

  • Antiplatelet therapy such as aspirin

  • Anticoagulation therapy such as warfarin or apixaban

• Procedures

  • Stenoses can be stented to keep vessel patent

  • Treating a patent foramen ovale (PFO) if patients have one

• Medical follow-up with a physician

Emerging and Advanced Concepts10

Future of stroke prevention

• Neuroprotection research to discover solutions for excitotoxity, oxidative stress, and inflammation

• Precision medicine such as genetic profiling and personalized plans

• Machine learning predictive measures can help improve early detection on imaging

Review Questions

ANSWER KEY

1. D