Abstract Much of the decline in stroke incidence and
mortality for the past several decades in Western countries
has been attributed to better treatment of risk factors. Many
epidemiological studies and clinical trials confirmed the
importance of managing hypertension. Comparative trials of
anti-hypertensive drugs or drug classes have not yielded clear
results, but blood pressure variability may play an important
role beyond the absolute value of blood pressure. Diabetes
therapy remains a conundrum. Although diabetes is clearly a
risk factor for ischemic stroke, treatment trials targeting
different glycemic goals have not indicated that glucose
lowering results in stroke prevention. Trials focused on
insulin resistance are ongoing and they may be able to help
establish the management of diabetes/impaired glucose
tolerance. Evidence for treatment of dyslipidemia has
contrasted science to diabetes mellitus. Dyslipidemia has not
been strongly or consistently linked to ischemic stroke but the
Stroke Prevention by Aggressive Reduction in Cholesterol
Levels (SPARCL) trial showed the impact of statin treatment
in stroke prevention. The results of clinical trials investigating
dabigatran and rivaroxaban clearly indicate alternative strategies
to vitamin K antagonists in stroke prevention for
persons with atrial fibrillation. Evidence for stroke prevention
by life style modification, treating metabolic syndrome, sleep
disordered breathing, lipoprotein (a), hyperhomocysteinemia,
and coagulation disorders are also discussed.
Abstract Much of the decline in stroke incidence andmortality for the past several decades in Western countrieshas been attributed to better treatment of risk factors. Manyepidemiological studies and clinical trials confirmed theimportance of managing hypertension. Comparative trials ofanti-hypertensive drugs or drug classes have not yielded clearresults, but blood pressure variability may play an importantrole beyond the absolute value of blood pressure. Diabetestherapy remains a conundrum. Although diabetes is clearly arisk factor for ischemic stroke, treatment trials targetingdifferent glycemic goals have not indicated that glucoselowering results in stroke prevention. Trials focused oninsulin resistance are ongoing and they may be able to helpestablish the management of diabetes/impaired glucosetolerance. Evidence for treatment of dyslipidemia hascontrasted science to diabetes mellitus. Dyslipidemia has notbeen strongly or consistently linked to ischemic stroke but theStroke Prevention by Aggressive Reduction in CholesterolLevels (SPARCL) trial showed the impact of statin treatmentin stroke prevention. The results of clinical trials investigatingdabigatran and rivaroxaban clearly indicate alternative strategiesto vitamin K antagonists in stroke prevention forpersons with atrial fibrillation. Evidence for stroke preventionby life style modification, treating metabolic syndrome, sleepdisordered breathing, lipoprotein (a), hyperhomocysteinemia,and coagulation disorders are also discussed.
การแปล กรุณารอสักครู่..
