Clinical Review Regular review

Prevention of ischaemic stroke

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7274.1455 (Published 09 December 2000) Cite this as: BMJ 2000;321:1455
  1. Gord Gubitz, assistant professor ([email protected])a,
  2. Peter Sandercock, professorb
  1. a Division of Neurology, Queen Elizabeth II Health Sciences Centre, Halifax B3H 3A7, Canada
  2. b Department of Clinical Neurosciences, Western General Hospitals NHS Trust, Edinburgh EH4 1DP
  1. Correspondence to: G Gubitz
  • Accepted 17 July 2000

Recent advances in the treatment of acute ischaemic stroke have focused largely on drug treatments, and yet the number of effective and widely practicable treatments remains limited. After a spate of trials with negative results, no neuroprotective agents have yet been licensed for acute stroke. Although thrombolysis with tissue plasminogen activator is now available in the United States and Canada, most eligible patients are not treated, and thrombolysis remains the subject of considerable debate in the international research community. 1 2 Other important interventions for people with acute stroke include organised care in multidisciplinary stroke units and routine use of aspirin in acute ischaemic stroke. 3 4 Stroke is the second most common cause of death worldwide, and with no major panacea for acute stroke imminent, we must not ignore stroke prevention.5

Medical and surgical treatments to prevent stroke carry some risk (and some cost). These preventive strategies should be targeted at those who are at the highest absolute risk of stroke, because these individuals are likely to derive the greatest absolute benefit.6 These patients generally have a history of occlusive vascular diseases with symptoms— that is, prior ischaemic stroke or transient ischaemic attack, coronary heart disease, or peripheral vascular disease. Among the 80% of patients who survive an acute stroke, the risk of recurrent stroke is highest within the first few weeks and months; about 10% in the first year and about 5% per year thereafter. These patients are also at a major risk of other vascular disease, including myocardial infarction, emphasising the need for early preventive treatments.7 Individual risk factors such as a history of hypertension, smoking, hyperlipidaemia, increased blood glucose concentration, and obesity are important considerations for all patients, especially those at high risk.

Summary points

Reduction of blood pressure is effective at preventing a first …

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