Secondary prevention for stroke and transient ischaemic attacks: Horizons needs expanding

doi:10.1136/bmj.328.7444.896-a

BMJ 2004;328:896 (10 April), doi:10.1136/bmj.328.7444.896-a

Letter

Secondary prevention for stroke and transient ischaemic attacks

Horizons needs expanding

The first 150 words of the full text of this article appear below.

EDITOR—Acute stroke and transient ischaemic attacks areemergencies, and Muir in his editorial has presented recentevidence, showing that reduction of blood pressure and cholesterol,regardless of baseline values, have unequivocal benefit in secondaryprevention.¹

There is no real boundary between acute treatment and secondaryprevention, which should start very early. This is best donein a dedicated stroke unit, to enhance the multidisciplinaryapproach and minimise delays, leading to better recovery.²

There is evidence that high blood glucose is detrimental aftera stroke. Although exact underlying mechanisms remain unclear,evidence shows clinical worsening, with hyperglycaemia and increasedrisk of a second stroke with poor long term control.³

Non-fasting total homocysteine is another independent risk factorin both sexes over 60. Screening for elevated homocysteine concentrationsand folate therapy may play an important part in secondary prevention.Concentrations higher than 14 µmol/l are associated withan 80% increase . . . [Full text of this article]

Sumantra Ray, clinical research fellow

sumantra.ray{at}tuht.scot.nhs.uk

Alexander S F Doney, specialist registrar, Ronald S MacWalter, consultant physician

Stroke Studies Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY

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