Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Actual directions in the primary prevention of ischemic stroke

Full Text:


Basic directions in the primary prevention of ischemic stroke are presented. Population and high-risk strategies are identified in the system of primary prevention of stroke. The population strategy proposes the use of diverse medical, social, and educational measures that promote the elimination of the negative impact of lifestyle, nutrition, and environment on the incidence of stroke. The high-risk strategy implies individual preventive management in patients at high risk for cardiovascular events. Adequate antihypertensive therapy with blood pressure goals being achieved; antithrombotic therapy with a drug being rationally chosen; normalization of lipid metabolic parameters; and substantiated surgical intervention into the carotid arteries are able to substantially reduce the risk of primary stroke.


1. <div><p>Инсульт: диагностика, лечение, профилактика. Под ред. З.А. Суслиной, М.А. Пирадова. М.: МЕДпресс-информ, 2009;288 с.</p><p>Эпидемиология инсульта в России. Гусев Е.И., Скворцова В.И., Стаховская Л.В. и др. Consilium medicum 2005;1:5-7.</p><p>O`Rourke F., Dean N., Akhtar N. et al. Current and future concepts in stroke prevention. CMAJ 2004;170(7): 1123-33.</p><p>Goldstein L.B., Bushnell Ch.D., Adams R.J. et al. Guidelines for the primary prevention of stroke. A guideline for healthcare professionals from the American Heart AssociationAmerican Stroke Association. Stroke 2011;42:517-84.</p><p>The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attacks 2008. Cerebrovasc Dis 2008;25:457-507.</p><p>Appel L.J., Brands M.W., Daniels S.R. et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006;47:296-308.</p><p>US Dept of Health and Human Services and US Dept of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, DC: US Government Printing Office, 2005.</p><p>Lee C.D., Folsom A.R., Blair S.N. Physical activity and stroke risk: a meta-analysis. Stroke 2003;34:2475-81.</p><p>Wang H.Y., Bashore T.R., Friedman E. Exercise reduces age-dependent decrease in platelet protein kinase C activity and translocation. J Gerontol And Biol Sci Med Sci 1995;50A:M12-М6.</p><p>Williams P.T. High-density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners. N Engl J Med 1996;334:1298-303.</p><p>Flegal K.M., Shepherd J.A., Looker A.C. et al. Comparisons of percentage body fat, body mass index, waist circumference, and waiststature ratio in adults. Am J Clin Nutr 2009;89:500-8.</p><p>Neter J.E., Stam B.E., Kok F.J. et al. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003;42:878-84.</p><p>Ninomiya J.K., L'Italien G., Criqui M.H. et al. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004;109:42-6.</p><p>Chiuve S.E., Rexrode K.M., Spiegelman D. et al. Primary prevention of stroke by healthy lifestyle. Circulation 2008;118:947-54.</p><p>Hillbom M., Numminen H., Juvela S. Recent heavy drinking of alcohol and embolic stroke. Stroke 1999;30:2307-12.</p><p>Feigin V.L., Rinkel G.J., Lawes C.M. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005;36:2773-80.</p><p>Manolio T.A., Kronmal R.A., Burke G.L. et al. Short-term predictors of incident stroke in older adults: the Cardiovascular Health Study. Stroke 1996;27:1479-86.</p><p>Kool M.J., Hoeks A.P., Struijker Boudier H.A. et al. Short- and long-term effects of smoking on arterial wall properties in habitual smokers. J Am Coll Cardiol 1993;22:1881-6.</p><p>Silvestrini M., Troisi E., Matteis M. et al. Effect of smoking on cerebrovascular reactivity. J Cereb Blood Flow Metab 1996;16:746-9.</p><p>Song Y.M., Cho H.J. Risk of stroke and myocardial infarction after reduction or cessation of cigarette smoking: a cohort study in Korean men. Stroke 2008;39:2432-8.</p><p>UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complication in type 2 diabetes: UKPDS 38. BMJ 1998;317:703-13.</p><p>Gerstein H.C., Miller M.E., Byington R.P. et al. Effects of intensive glucose lowering in type diabetes. N Engl J Med 2008;358:2545-59.</p><p>Skyler J.S, Bergenstal R., Bonow R.O. et al. Intensive glycemic control and the prevention of ardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation 2009;119:351-7.</p><p>Kannel W.B., Wolf P.A., McGee D.L. et al. Systolic blood pressure, arterial rigidity, and risk of stroke: the Framingham Study. J Am Med Assoc 1981;245:1225-9.</p><p>Prospective Studies Collaboration. Cholesterol, diastolic blood pressure and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts. Lancet 1995;346:1647-53.</p><p>Stamler J., Stamler R., Neaton J. Blood pressure and diastolic and cardiovascular risk: a prospective observation study. Am J Epidemiol 1993;142:1279-90.</p><p>Collins R., MacMahon S.W. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994;50:272-98.</p><p>Суслина З.А., Танашян М.М., Домашенко М.А. Антитромботическая терапия ишемических нарушений мозгового кровообращения. М.: МИА, 2009;224 с.</p><p>Bousser M-G. Antithrombotic agents in the prevention of ischemic stroke. Cerebrovasc Dis 2009;27(Suppl. 3):12-9.</p><p>The Medical Research Council`s General Practice Research Framework. Thrombosis prevention trial: randomized trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischemic heart disease in men at increased risk. Lancet 1998;351:233-41.</p><p>Feinberg W.M., Blackshear J.L., Laupasic A. et al. Prevalence, age distribution and gender of patients with atrial fibrillation: analysis and implication. Arch Intern Med 1995;155:469-73.</p><p>Практическая кардионеврология. Под ред. З.А. Суслиной, А.В. Фонякина. М.: ИМА-ПРЕСС, 2010;304 с.</p><p>Brandt F.N., Abbot R.D., Kannel W.B. et al. Characteristics and prognosis of lone atrial fibrillation: 30-year follow-up in the Framingham study. JAMA 1985;254:3449-53.</p><p>Hart R.G., Pearce L.A., McBride R. et al. for the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. Stroke 1999;30:1223-9.</p><p>Hylek E.M., Skates S.J., Sheechan M.A. et al. An analysis of the lowest effective intensity of prophylactic anticoagulantion for the patients with nonrheumatic atrial fibrillation. N Engl J Med 1996;335:540-6.</p><p>Gage B.F., Waterman A.D., Shannon W. et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation JAMA 2001;285:2864-70.</p><p>Connolly S.J., Ezekowitz M.D., Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.</p><p>Patel M.R., Mahaffey K.W., Garg J. et al. Randomized, double-blind study comparing once daily oral rivaroxaban with adjusted-dose oral warfarin for the prevention of stroke in subjects with non-valvular atrial fibrillation. N Engl J Med 2011;365:883-91.</p><p>Granger C.B., Alexander J.H., McMurray J.J. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-92.</p><p>Antithrombotic Tralists` Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. BMJ 2002;324:71-86.</p><p>Ridker P.M., Cook N.R., Lee I.M. et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352:1293-304.</p><p>Greving J.P., Buskens E., Koffijberg H. et al. Cost effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender and varying cardiovascular risk. Circulation 2008;117:2875-83.</p><p>Belch J., MacCuish A., Campbell I. et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:a1840.</p><p>Qizilbash N., Lewington S., Duffy S. et al. Cholesterol, diastolic blood pressure and stroke: 13 000 stroke in 450 000 people in 45 prospective cohorts: Prospective Studies Collaboration. Lancet 1995;346:1647-53.</p><p>Benfante R., Yano K., Hwang L.J. et al. Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men: implications of shared risk. Stroke 1994;25:814-20.</p><p>Kargman D.E., Tuck C., Berglund L.F. et al. Elevated high density lipoprotein levels are more important in atherosclerotic ischemic stroke subtypes: the Northen Manhattan Stroke Study. Ann Neurol 1998;44:442-3.</p><p>Hjermann I., Velve Byre K., Holme I. et al. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomized trial in healthy men. Lancet 1981;2(8259):1303-10.</p><p>Shepherd J., Cobbe S.M., Ford I. et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterinemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995;333:1301-7.</p><p>The LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998;339:1310-49.</p><p>The Heart Protection Study Coollaborative Group. MRC/BHF Heart protection study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomized placebocontrolled trial. Lancet 2002;360:7-22.</p><p>Ridker P.M., Danielson E., Fonseca F.A. et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195-207.</p><p>Национальные клинические рекомендации (ВНОК). Сборник. Под ред. Р.Г. Оганова. 2-е изд. М.: Силицея-Полиграф, 2009;528 с.</p><p>Liapis C.D., Bell P.R.F., Mikhailidis D. et al. ESVS Guidelines. Invasive Treatment for Carotid Stenosis: Indications, Techniques. Eur J Vasc Endovasc Surg 2009;37:S1-S19.</p><p>Brott T.G., Halperin J. L., Abbara S. et al. Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011;57:e16-e94.</p><p>Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8.</p><p>Halliday A., Mansfield A., Marro J. et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet 2004;363:1491-502.</p><p>Hobson R.W. 2nd, Weiss D.G., Fields W.S. et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993;328:221-7.</p><p>Yadav J.S., Wholey M.H., Kuntz R.E. et al. the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-501.</p><p>Brott T.G., Hobson R.W. 2nd, Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010;363:11-23.</p><p>Abbott A.L. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke 2009;40:e573-83.</p><p>Marquardt L., Geraghty O.C., Mehta Z. et al. Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke 2010;41:e11-е17.</p><p>Rothwell P.M., Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke 2004;35:2425-7.</p><p>Симоненко В.Б., Широков Е.А. Превентивная кардионеврология. СПб.: ФОЛИАНТ, 2008;224 с.</p></div><br />

For citation:

Fonyakin A.V., Geraskina L.A. Actual directions in the primary prevention of ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2011;3(4):69-76. (In Russ.)

Views: 599

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)