nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2010-99nnp-55Research ArticleREVIEWSОБЗОРЫFaktory riska povtornogo ishemicheskogo insul'ta i ego profilaktikaФакторы риска повторного ишемического инсульта и его профилактикаПарфеновВ. А.ParfenovV. A.vladimirparfenov@mail.ruПервый МГМУ им. И.М. СеченоваРоссияI.M. Sechenov First Moscow Medical UniversityRussian Federation20101409201023NO3 (2010)4046Copyright © Parfenov V.A., 20102010Парфенов В.А.Parfenov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/55

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Профилактика инсульта имеет не только медицинское, но и большое социальное значение, так как инсульт – третья по частоте причина смертности и одна из главных причин инвалидности [1–5]. Вероятность повторного инсульта увеличивается более чем в 10 раз у пациентов, перенесших инсульт или транзиторную ишемическую атаку (ТИА), поэтому его профилактика особенно важна у этих пациентов [4, 5]. Риск повторного инсульта максимален в первые дни после ТИА или ишемического инсульта (ИИ), поэтому профилактику нужно начинать как можно раньше после развития первого инсульта или ТИА [4, 5]. Профилактика инсульта основывается на коррекции факторов риска его развития и включает в себя лекарственные и хирургические методы, а также изменение образа жизни.

References<div><p>Дамулин И.В., Парфенов В.А., Скоромец А.А. и др. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Рук-во для врачей. Под ред. Н.Н. Яхно. Т.1. М.: Медицина, 2005;232-303.</p><p>Суслина З.А., Танашян М.М., Ионова В.Г. Ишемический инсульт: кровь, сосудистая стенка, антитромботическая терапия. М., 2005;248 с.</p><p>Фейгин В., Виберс Д., Браун Р. Инсульт: Клиническое руководство. М.: Бином; СПб.: Диалект, 2005;608 с.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>Brown R.D., Whisnant J.P., Sicks J.D. et al. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996;27:373-80.</p><p>Appelros P., Stegmayr B., Terent A. Sex Differences in Stroke Epidemiology. Stroke 2009;40:1082-90.</p><p>Bhat V.M., Cole J.W., Sorkin J.D. et al. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke 2008;39:2439-43.</p><p>Patra J., Taylor B., Irving H. 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Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomized controlled trial. Lancet 2006;367:1665-73.</p><p>Sacco R.L., Diener H.C., Yusuf S. et al. Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke. N Engl J Med 2008;359:1238-51.</p><p>EAFT Group Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-62.</p><p>The ACTIVE Investigators Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009;360:2066-78.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741-8.</p><p>Post-stroke antihypertensive treatment study. A preliminary result. PATS Collaborating Group. Chin Med J 1995;108:710-7.</p><p>Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033-41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218-26.</p><p>Amarenco P., Bogousslavsky J., Amarenco P. et al. High dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355:549-59.</p><p>Fenundez de Bobadilla J., Moreno R., Fenundez C. et al. Effect of intensive treatment with atorvastatin versus standard doses of statins on the risk of stroke. A meta-analysis from five randomized trials including 25,709 patients. Rev Neurol 2009;48:561-5.</p><p>Rothwell P.M., Eliasziw M., Gutnikov S.A. et al. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915-24.</p></div><br /><div><p>Дамулин И.В., Парфенов В.А., Скоромец А.А. и др. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Рук-во для врачей. Под ред. Н.Н. Яхно. Т.1. М.: Медицина, 2005;232-303.</p><p>Суслина З.А., Танашян М.М., Ионова В.Г. Ишемический инсульт: кровь, сосудистая стенка, антитромботическая терапия. М., 2005;248 с.</p><p>Фейгин В., Виберс Д., Браун Р. Инсульт: Клиническое руководство. М.: Бином; СПб.: Диалект, 2005;608 с.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>Brown R.D., Whisnant J.P., Sicks J.D. et al. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996;27:373-80.</p><p>Appelros P., Stegmayr B., Terent A. Sex Differences in Stroke Epidemiology. Stroke 2009;40:1082-90.</p><p>Bhat V.M., Cole J.W., Sorkin J.D. et al. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke 2008;39:2439-43.</p><p>Patra J., Taylor B., Irving H. Alcohol consumption and the risk of morbidity and mortality for different stroke types - a systematic review and meta-analysis. BMC Public Health 2010;10:258.</p><p>Suk S.H., Sacco R.L., Boden-Albala B. et al. For the Northern Manhattan Stroke Study. Abdominal obesity and risk of ischemic stroke: the Northern Manhattan Stroke Study. Stroke 2003;34:1586-92.</p><p>Lawes C.M.M., Bennett D.A., Feigin V.L. et al. Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:776-85.</p><p>Chalmers J., MacMahon S., Anderson C. et al. Clinician's Manual on Blood Pressure &amp; Stroke Prevention. 2nd ed. London: Science Press, 2000;78.</p><p>Hillen T., Coshall C., Tilling K. et al. For the South London Stroke Register. Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke 2003;34:1457-63.</p><p>Ebrahim S., Sung J., Song Y.-M. et al. Serum cholesterol, haemorrhagic and ischaemic stroke: the Korean National Health Service prospective cohort study. Cerebrovasc Dis 2005;19 (Suppl. 2):1-6.</p><p>Horenstein R.B., Smith D.E., Mosca L. Cholesterol predicts stroke mortality in the Women's Pooling Project. Stroke 2002;33:1863-8.</p><p>Saposnik G., Ray J.G., Sheridan P. et al. Homocysteine-Lowering Therapy and Stroke Risk, Severity, and Disability. Stroke 2009;40:1365-72.</p><p>Caplan L.R., Wong K.S., Gao S. et al. Is Hypoperfusion an Important Cause of Strokes? If So, How? Cerebrovasc Dis 2006;21:145-53.</p><p>Levine S.R., Brey R.L., Tilley B.C. et al. For the APASS Investigators. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004;291:576-84.</p><p>Schürks M., Rist P.M., Bigal M.E. et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009;339:b3914.</p><p>CAPRIE Streering Commitee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996;348:1329-39.</p><p>Diener H.C., Cunha L., Forbes C. et al. European Stroke Prevention Study, 2: dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996;143:1 - 13.</p><p>Weimar C., Diener H.C., Alberts M.J. et al. The Essen Stroke Risk Score Predicts Recurrent Cardiovascular Events A Validation Within the REduction of Atherothrombosis for Continued Health (REACH) Registry. Stroke 2009;40:350-7.</p><p>Reynolds K., Lewis B., Nolen J.D. et al. Alcohol consumption and risk of stroke: a meta-analysis. JAMA 2003;289:579-88.</p><p>Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Antithrombotic Trialists' Collaboration. BMJ 2002;324:71-86.</p><p>The ESPRIT Study Group. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomized controlled trial. Lancet 2006;367:1665-73.</p><p>Sacco R.L., Diener H.C., Yusuf S. et al. Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke. N Engl J Med 2008;359:1238-51.</p><p>EAFT Group Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-62.</p><p>The ACTIVE Investigators Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009;360:2066-78.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741-8.</p><p>Post-stroke antihypertensive treatment study. A preliminary result. PATS Collaborating Group. Chin Med J 1995;108:710-7.</p><p>Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-53.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033-41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218-26.</p><p>Amarenco P., Bogousslavsky J., Amarenco P. et al. High dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006;355:549-59.</p><p>Fenundez de Bobadilla J., Moreno R., Fenundez C. et al. Effect of intensive treatment with atorvastatin versus standard doses of statins on the risk of stroke. A meta-analysis from five randomized trials including 25,709 patients. Rev Neurol 2009;48:561-5.</p><p>Rothwell P.M., Eliasziw M., Gutnikov S.A. et al. Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915-24.</p></div><br />

The authors declare that there are no conflicts of interest present.