Prevention of ischemic stroke in clinical practice: a role of internists and general practitioners

Area of Science:

• Neurology
• Cardiovascular Medicine
• Public Health

Background:

• Stroke is a major global cause of death and disability, posing significant clinical and socio-economic challenges.
• Despite decreased in-hospital mortality, stroke remains a critical public health concern, necessitating robust prevention strategies.
• Recent advancements in neuroimaging and thrombolysis have led to updated definitions of stroke and transient ischemic attack (TIA).

Purpose of the Study:

• To emphasize the critical importance of stroke prevention and cardiovascular risk control.
• To highlight the need for prompt clinical evaluation, risk assessment, and management for both stroke and TIA patients.
• To outline comprehensive secondary prevention strategies for ischemic stroke.

Main Methods:

• Review of current understanding of stroke and TIA definitions and risk factors.
• Analysis of established and emerging secondary prevention strategies for ischemic stroke.
• Identification of key modifiable cardiovascular risk factors contributing to stroke incidence.

Main Results:

• Five primary cardiovascular risk factors (hypertension, smoking, obesity, diet, physical inactivity) account for 80% of stroke cases.
• Secondary prevention involves early interventions like antiplatelets and carotid procedures, alongside long-term management.
• Long-term management includes lifestyle changes, antihypertensive therapy, antiplatelets, anticoagulation for atrial fibrillation, and lipid-lowering drugs.
• Stroke patients face risks of depression, dementia, and epilepsy, requiring targeted treatments.

Conclusions:

• Stroke and TIA are recurrent and preventable conditions requiring immediate clinical attention and risk stratification.
• Comprehensive secondary prevention, encompassing lifestyle modifications and targeted medical therapies, is essential for reducing recurrence and cardiovascular events.
• Effective management of cardiovascular risk factors is paramount in mitigating the global burden of stroke.