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Published on: July 2, 2013
Long-term therapy to prevent stroke
Howard S Kirshner1, José Biller, Alfred S Callahan
1Department of Neurology, Vanderbilt University Medical Center, 2100 Pierce Avenue, Nashville, TN 37212, USA. Howard.Kirshner@vanderbilt.edu
Insights
Preventing ischemic strokes is achievable with current treatments for blood pressure, cholesterol, and antithrombotic therapies. Increased public and physician education is crucial for applying these widely available preventive measures.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Cerebrovascular disease is a leading cause of death and disability in the US.
- Ischemic strokes often result from platelet-fibrin thrombi on atherosclerotic plaques.
- Atherothrombosis underlies stroke, coronary artery disease, and peripheral artery disease, indicating systemic risk.
Purpose of the Study:
- To highlight the preventability of ischemic strokes.
- To emphasize the availability of current preventive treatments.
- To underscore the need for improved application of these treatments.
Main Methods:
- Review of existing data on stroke causes and prevention.
- Analysis of the systemic nature of atherothrombosis.
- Assessment of current treatment availability and application gaps.
Main Results:
- Up to 80% of ischemic strokes may be preventable with existing therapies.
- Preventive treatments for blood pressure, cholesterol, and antithrombotic use are well-established.
- A significant gap exists in the application of these treatments to at-risk populations.
Conclusions:
- Stroke prevention is achievable through the consistent application of known medical interventions.
- Enhanced public education and primary care physician engagement are vital for improving stroke prevention rates.
- Focus should be on implementing existing strategies rather than awaiting new breakthroughs.
Abstract:
Cerebrovascular disease is the third leading cause of mortality and the leading cause of long-term neurological disability in the United States. Most strokes are of ischemic origin and, other than cardioembolic or small vessel strokes, are caused by the development of platelet-fibrin thrombi on an atherosclerotic plaque. This underlying disease mechanism shares important features with coronary artery disease and peripheral artery disease, highlighting the systemic nature of atherothrombosis and the elevated cross risk in stroke patients for ischemic events in other vascular beds. It has been estimated that up to 80% of ischemic strokes could be prevented with application of currently available treatments for blood pressure, cholesterol, and antithrombotic therapies. Stroke is not, like cancer, waiting for a scientific breakthrough; stroke preventive treatments are well understood and widely available. It is only the application of these treatments to patients, many of whom do not visit physicians, that is lacking. Clearly, better education of the public and active participation of primary care physicians is essential to get the message out to all those at risk.
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