Primary stroke prevention

Article by Master, Doctor Nguyen Thi Minh Phuong - Doctor of Neurology - Department of General Internal Medicine - Vinmec Times City International Hospital

Stroke is the leading cause of permanent disability. 90% of strokes are preventable and are caused by 10 modifiable risk factors. Therefore, prevention of primary and secondary stroke is of great importance and is a top priority.

The prevention of ischemic stroke includes lifestyle modification, diet, and medication for people with risk factors including hypertension, diabetes, and dyslipidemia. Simultaneously, antiplatelet therapy for patients at high vascular risk and anticoagulation in atrial fibrillation is recommended.

Lifestyle changes including a healthy diet, weight loss, cessation of smoking and regular physical activity.
Because high blood pressure is the main risk factor for stroke. Therefore, a diet low in salt, rich in potassium, and limited in alcohol will help control blood pressure better. Increased physical activity can reduce stroke risk by 25-30% because of its positive effects on blood pressure and diabetes control. According to the recommendations of the US Department of Health and Human Services, the average person should participate in at least 150 minutes (2 hours 30 minutes) per week of moderate intensity or 75 minutes (1 hour 15 minutes) per week of physical activity. intense physical activity. In overweight and obese individuals, weight loss is recommended to reduce blood pressure and stroke risk. Don't smoke: Many studies have shown that smoking causes increased atherosclerosis of blood vessels, increased blood fat and increased blood clot formation, which is the main cause of cerebral infarction.

Hypertension is the most important modifiable risk factor for ischemic stroke. The risk of stroke increases with increasing blood pressure, independent of other factors. Measures to improve and treat high blood pressure such as:
Control blood pressure with lifestyle changes, behavior and medication use. In a meta-analysis of 23 randomized trials of antihypertensive drug therapy versus no drug treatment, the risk of stroke was reduced by 32% with drug treatment. In hypertensive patients with diabetes or renal disease, the blood pressure goal is <130/80 mm Hg.

Diabetes is estimated to increase the relative risk of ischemic stroke from 1.8 to nearly 6 times, independent of other risk factors. In addition, many diabetic patients have hypertension and dyslipidemia, both of which are significant risk factors for stroke.
Therefore, patients should use antihypertensive drugs including ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Diabetics need to adjust their lifestyle, diet, and medication according to the doctor's instructions to control blood sugar well.

Elevated total cholesterol and LDL cholesterol have been associated with an increased risk of ischemic stroke in several epidemiological studies. Epidemiological studies have also shown an inverse relationship between high-density lipoprotein (HDL) cholesterol and stroke risk.
For every 1 mmol/l reduction in LDL cholesterol levels with statin therapy, the risk of first stroke is reduced by approximately 21%. Encourage the use of statin therapy and lifestyle changes to control blood lipids. Among statins, atorvastatin and rosuvastatin were the most effective in reducing cardiovascular events.

According to research, atrial fibrillation (AF) embolism accounts for about 10% of all ischemic strokes in the United States. In particular, atrial fibrillation was associated with a 4-5 times increased risk of ischemic stroke, independent of heart valves.
Therefore, doctors often recommend screening for atrial fibrillation in patients over 65 years of age because atrial fibrillation-related stroke can occur in older patients with undiagnosed atrial fibrillation. If atrial fibrillation is diagnosed, treatment with anticoagulation should be prescribed by your doctor.

Approximately 20% of ischemic strokes are caused by an embolism from the heart. Heart conditions associated with increased risk of stroke include arrhythmias, heart tumors, valvular heart disease, heart valve disease, prosthetic valves, dilated cardiomyopathy, coronary artery disease, endocarditis and congenital heart defects (patent foramen ovale, atrial septal defect, atrial septal defect). On a case-by-case basis, your doctor will prescribe anti-thrombotic drugs to prevent stroke.

Atherosclerotic stenosis of the extracranial internal carotid artery or carotid aneurysm is associated with an increased risk of stroke. Depending on the severity of the artery stenosis and other risk factors, the doctor will choose preventive treatment with drugs or interventional balloon angioplasty, stenting or surgical removal of the atheroma.
Periodic health checkup is also one of the primary ways to prevent stroke, from which to have a treatment plan for optimal results. Currently, Vinmec International General Hospital has general health checkup packages suitable for each age, gender and individual needs of customers with a reasonable price policy, including:
Health checkup package diamond general health check-up package Vip special health check-up package Comprehensive general health check-up package Standard general health check-up package Patient's examination results will be returned to your home. After receiving the results of the general health examination, if you detect diseases that require intensive examination and treatment, you can use services from other specialties at the Hospital with quality treatment and services. outstanding customer service.