Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar

J Am Coll Cardiol. 2020 Apr 21;75(15):1804-1818. doi: 10.1016/j.jacc.2019.12.072.

Abstract

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation.

Keywords: antithrombotic therapy; cerebral hemorrhage; diabetes; hypertension; stroke; stroke prevention.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Arterial Occlusive Diseases / surgery
  • Carotid Stenosis / complications
  • Carotid Stenosis / therapy
  • Cerebral Arteries / surgery
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / prevention & control*
  • Fibrinolytic Agents / therapeutic use
  • Foramen Ovale, Patent / surgery
  • Humans
  • Hyperglycemia / complications
  • Hyperglycemia / therapy
  • Hyperlipidemias / complications
  • Hyperlipidemias / therapy
  • Hypertension / complications
  • Hypertension / therapy
  • Ischemic Stroke / etiology
  • Ischemic Stroke / prevention & control*
  • Life Style
  • Platelet Aggregation Inhibitors / therapeutic use
  • Primary Prevention*
  • Risk Factors
  • Secondary Prevention*
  • Stents
  • Vertebrobasilar Insufficiency / complications
  • Vertebrobasilar Insufficiency / surgery
  • Vitamin B Complex / therapeutic use

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Vitamin B Complex