Implications of stroke prevention trials: treatment of global risk.
Clinical trials have demonstrated that risk of cardiovascular events may be reduced in patients with stroke, using blood pressure (BP) reduction and statin therapy, independently of the presence of specific risk factors. These results suggest an alternative approach to secondary stroke prevention, focused more on global risk than on detection and modification of individual categorical risk factors such as hypertension, dyslipidemia, and diabetes mellitus. A risk-based approach is warranted because stroke patients are at high risk of several cardiovascular events, not just stroke, and because physiologic risk factors such as BP demonstrate a continuous, or log-linear, relationship with cardiovascular risk. Essential to the implementation of such an approach is the development of adequate risk stratification models for stroke patients. Based on limited available evidence, however, it appears that most patients who experience an ischemic stroke or TIA are at high long-term absolute risk of a subsequent cardiovascular event and should be treated with all available risk-reduction strategies.
Elkind
Mitchell S V
MS
Department of Neurology, Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, and Columbia University Medical Center of New York-Presbyterian Hospital, New York, NY, USA. mse13@columbia.edu
D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015897:Comorbidity; D017408:Guidelines as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000517:prevention & control* / Q000628:therapy*
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors