[Stroke. Options for primary prevention]

Age, gender, race, and genetic factors count among the nonmodifiable risk factors for stroke. But primary prevention is possible through modification of other vascular risk factors. The treatment of arterial hypertension, with optimal values around 135/85 mmHg, reduces the risk of stroke by 50%. A significant risk reduction for ischemic stroke is possible with at least 30 minutes of physical activity twice a week, cessation of cigarette smoking, and treatment of hypercholesterolemia with statins. Dietary measures should include a reduction of animal proteins, normalization of body weight and a large amount of fruit and vegetables; small amounts of wine are allowed. A hyperhomocystinemia is treated with folic acid. Low dose estrogens (< 50 micrograms) do not increase the risk of ischemic stroke in young females, but are capable of reducing hypercholesterolemia in postmenopausal women if triglycerides are normal. Neither primary prevention of stroke with antiagreggants nor surgery for asymptomatic carotid artery stenoses is recommended as preventive treatment, but low dose anticoagulation is the prophylaxis of choice for atrial fibrillation.