Stroke prevention in the high-risk patient

Abstract

Strokes are increasing in number due to an ageing population and are largely preventable. In the highest risk patients, a 90% relative risk reduction for stroke is attainable by appropriately using all the measures proven to reduce stroke: smoking cessation, a Mediterranean diet, control of hypertension, anticoagulants or antiplatelet agents, lipid lowering drugs and appropriate carotid endarterectomy. Vitamin therapy to lower homocysteine and carotid stenting are additional measures that may yet prove beneficial. Diet, smoking cessation and appropriate carotid endarterectomy reduce stroke by more than do pharmacotherapies. Blood pressure control depends more on selecting appropriate therapy individualised for the patient, than on using any particular drug class. This review, therefore, places pharmacotherapy in perspective as part of, but not all of, stroke prevention.

Keywords::

• anticoagulant
• antihypertensive
• antiplatelet
• bupropion
• endarterectomy
• nicotine patch
• vitamin

Disclosure

In the last 5 years JD Spence has received research grants from Pfizer Canada, GlaxoSmithKline Canada, Pan American Laboratories, and vitamins and matching placebo for a clinical trial from Pan American Laboratories. He has received honoraria for lectures from AstraZeneca, Solvay and Wyeth Consumer Healthcare. He has also received consulting fees from Novartis, Pan American Laboratories, Wyeth Consumer Healthcare and Medice Arzneimittel Pütter GmbH & Co.