Stroke prevention


Age increases susceptible to stroke, as does having a mother, father, or other close relative who has had a stroke.

Lower blood pressure

High blood pressure doubles  or even quadruples   stroke risk if it is not controlled.

High blood pressure is the biggest contributor to the risk of stroke in both men and women. 

Stroke prevention: 


Reducing  salt in the  diet, ideally to no more than 1,500 milligrams a day.


Increase polyunsaturated and monounsaturated fats in the diet, while avoiding foods high in saturated fats.


Eating 4 to 5 cups of fruits and vegetables every day, one serving of fish two to three times a week, and several daily servings of whole grains and low-fat dairy.


Increase exercise.


No smoking.


Normalize blood pressure.


Weight loss to ideal level.


Caloric restriction to pno more than 1,500 to 2,000 calories a day.


Drinking one drink per day, your risk may be lower,  and drinking more than two drinks per day, the risk goes up sharply.


Red wine contains resveratrol, which is thought to protect the heart and brain.


Treat atrial fibrillation


Treat diabetes


Quit smoking

Pharmacological Medical Management to prevent stroke due to large and small artery atherohrombosis has focused on anti-thrombotic therapies, blood pressure lowering medication, and low density lipoprotein cholesterol lowering with statins.

Cholesterol absorbing inhibitors ezetimbe and protein convertase subtilisin/Kexin type 9 inhibitors have demonstrated significant reduced LDL cholesterol and have reduced stroke in clinical trials.

Smoking accelerates clot formation by thickening the blood, and increases the amount of plaque buildup in the arteries. 


Immediate medical treatment with antiplatelet agents and statins, as well as blood pressure control, reduces the risk by 70-80% after a TIA or minor stroke.


No single antiplatelet drug has been shown to be superior to aspirin in the acute phase after TIA or minor stroke.


Ticagrelor does not significantly reduce the risk of stroke, myocardial infarction or death when given immediately after the onset of stroke symptoms.


The addition of dipyridamole to aspirin is no more effective than aspirin alone in preventing early recurrent ischemic stroke, aspirin plus clopidogrel is more effective than aspirin alone, however is associated with increased risk of extracranial bleeding.


In a trial involving patients with acute TIA or stroke, adding dipyridamole to aspirin and clopidogrel results in excess bleeding.


Ticagrelor Plus aspirin results in a lower incidence of ischemic stroke in patients with high-risk TIA or mild to moderate non-cardio embolic ischemic stroke: however dual antiplatelet therapy at higher risk of severe bleeding and no significant overall effect on disability or death.

The Women’s health study showed females taking aspirin experience a 17% decrease in stroke risk and most significantly reduced major events in females age 65 years and older.

Low-dose aspirin has a role in stroke prevention, particularly among all the adult females.

Females account for the majority of American population of 64 years and older and for stroke deaths.

After a non-fatal stroke females suffer more significant disability than males.

Strokes killed twice as many females as breast cancer.

Risk factors that could predispose females to strokes include multiple pregnancies, preeclampsia, postpartum period, and migraine.

Dual antiplatelet therapy for long term therapy has no advantage of a single agent therapy.

After a TIA and non-stable disabling stroke the greatest risk of recurrent stroke occurs in the first couple of weeks after the event and the addition of dual antiplatelet therapy for 2 to 3 weeks after TIA or a small stroke confers benefit.  

In the setting of ischemic stroke for TIA using high intensity lipid lowering therapy to achieve specific LDL target of less than 70 mg/dL that may reduce future events.

Cholesterol absorption Inhibitors, ezetimbe, and proprotein convertase subtisilin/Kexin type 9 inhibitors have demonstrated significant reduction in LDL cholesterol levels and efficacy in reducing stroke has been demonstrated in clinical trials.

Statins are no longer the only well tolerated cholesterol lowering class with medication with proven benefit for stroke prevention.

Eiciosopentatonic acid substantially lowers serum triglyceride levels in a manner free of adverse effects and is it has beneficial effects on the cell membrane stabilization  and lipid oxidation.

Eiciosopentatonic acid in patients with cardiovascular disease and elevated triglyceride levels lowers the risk of stroke significantly.

Pioglitazone increases insulin sensitivity in target tissues and is associated with reduced recurrent stroke in patients with ischemic stroke and insulin resistance, pre-diabetes and diabetes mellitus.

Glucagon like peptide-1 receptor agonists increase the synthesis of insulin by stimulating pancreatic islet cells and reduce glucagon secretion: in patients with type two diabetes and high cardiovascular risk GLP-1 receptive agonists are associated with reduced risk of stroke.

Folic acid food fortification is associated with reduced stroke.

Stroke prevention for non-valvular atrial fibrillation includes warfarin, factor Xa inhibitors and direct thrombin inhibitors.

For a patient with the antiphospholipid antibody syndrome warfarin remains the best agent, as it is for anticoagulant protection in patients with mechanical heart valve prosthesis.

The improvements in the management of vascular risk factors including smoking cessation, control of hypertension, hypercholesterolemia, and diabetes correlates with a major decline in the incidence of stroke in recent decades.

High intensity statin therapy, with a goal or of low density lipoprotein of less than 70, is recommended for secondary stroke prevention.

Patients with symptomatic stenosis of the cervical internal carotid artery of 50% or greater benefit from carotid endarterectomy: Endovascular placement of carotid artery stents may be an alternative.

In patients with the embolic stroke or TIA without apparent alternative cause and a patent foramen ovale, it is now recommended the patient undergo device closure.

Among patients with mild ischemic stroke or high risk TIA of presumed atherosclerotic cause, combined clopidogrel and aspirin therapy initiated within 72 hours after stroke onset lead to a lower risk of new stroke at 90 days than aspirin therapy alone, but was associated with a low but higher risk of moderate to severe bleeding. (INSPIRES investigators).





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