Stroke Prevention: Little-Known and Neglected Aspects.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Preventive Medicine

Background:

• Stroke remains a leading cause of disability and death.
• Current stroke prevention strategies can be further optimized by considering less recognized factors.
• A comprehensive approach is needed to address the multifactorial nature of stroke risk.

Purpose of the Study:

• To review and highlight lesser-known or neglected aspects of stroke prevention.
• To provide evidence-based recommendations for improving stroke risk reduction.
• To emphasize the importance of individualized and comprehensive stroke care.

Main Methods:

• Narrative review of existing literature on stroke prevention.
• Focus on specific, often overlooked, preventive measures and therapeutic considerations.
• Synthesis of information regarding diet, pharmacotherapy, and procedural interventions.

Main Results:

• Mediterranean diet and B vitamins for homocysteine reduction are effective.
• Coordinated smoking cessation and intensive lipid-lowering therapies are vital.
• Individualized hypertension management, considering arterial stiffness and renin/aldosterone levels, is crucial.
• Pharmacogenomic considerations (e.g., CYP2C19 variants) and aspirin resistance mechanisms impact treatment efficacy.
• Appropriate anticoagulation for embolic stroke of unknown source and careful selection of anticoagulants are important.
• Risk stratification for carotid stenosis interventions (endarterectomy vs. stenting) based on patient factors and age is necessary.

Conclusions:

• Integrating these overlooked aspects into clinical practice can significantly enhance stroke prevention.
• Personalized medicine approaches, including pharmacogenomics and individualized risk assessment, are key to optimizing stroke prevention.
• Further research and clinical attention to these areas are warranted to reduce the global burden of stroke.