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*It is only for medical professionals to read for reference.
How to use medicine to prevent stroke? October 29, 2021 is the 16th "World Stroke Day".
This year's theme is "Be aware of stroke symptoms and recognize and treat as soon as possible.
" So how should drugs be used to prevent stroke? Let's take a look with Jie Xiaoyao
.
Cerebral stroke, commonly known as "stroke", is a group of diseases that cause brain tissue damage due to sudden rupture of blood vessels in the brain or blood can not flow into the brain due to blockage of blood vessels, including ischemic and hemorrhagic strokes
.
Among them, ischemic stroke accounts for 60% to 70% of the total number of strokes
.
Due to the lack of effective treatment methods, it is currently believed that the best measure to reduce the incidence of stroke is prevention
.
The prevention of stroke is divided into primary prevention and secondary prevention
.
Primary prevention refers to the prevention before the onset of stroke, that is, through adopting various measures to correct unhealthy living habits early, and actively control the risk factors of stroke, so that healthy people can postpone the age of onset of stroke or avoid the occurrence of stroke
.
After a stroke occurs, continuing to actively treat the sequelae and control various risk factors to prevent recurrence of stroke is the basic content of secondary prevention
.
So, which drugs can be used for primary prevention? Which drugs are used for secondary prevention? How should they be administered? 1.
Angiotensin II receptor antagonist (ARB) hypertension is an important factor for stroke
.
ARB antihypertensive drugs are very important for preventing the occurrence and recurrence of stroke
.
■Valsartan Among the ARB drugs, valsartan is the drug with the most evidence-based medical evidence so far
.
In the case of the same blood pressure reduction, compared with the non-ARB drug group, the relative risk of new stroke in the valsartan group was significantly reduced
.
Evidence-based medicine evidence shows that, while lowering blood pressure, ARB can also reduce carotid artery intima-media thickness, improve insulin resistance, reduce cardiac remodeling, and reduce the occurrence and recurrence of atrial fibrillation.
It is used in preventing the occurrence and recurrence of stroke It is of great significance
.
■Losartan Recently, losartan has also been confirmed to further reduce the risk of stroke on the basis of the same lowering of blood pressure
.
Domestic experts pointed out that to strengthen the primary prevention of stroke in patients with hypertension, it is recommended to use antihypertensive treatments such as Losartan and other drugs with sufficient evidence-based evidence, conclusive efficacy and good tolerability, and strive to control blood pressure at a target level
.
2.
Statins lipid-lowering drugs Increased serum total cholesterol levels can increase the risk of ischemic stroke
.
Therefore, the prevention and treatment of dyslipidemia (mainly high cholesterol) is of great significance to the prevention of stroke
.
Statins are currently known to have the strongest cholesterol-lowering drugs, and have multidirectional effects, such as improving vascular endothelial function, inhibiting smooth muscle cell proliferation, inhibiting platelet aggregation, anti-inflammatory effects and stabilizing plaque, etc.
Help prevent stroke
.
Statins have been proven to significantly reduce the incidence of ischemic stroke and have a secondary preventive effect on ischemic stroke
.
■Simvastatin Simvastatin and other statins can reduce the risk of non-fatal and fatal strokes, including transient ischemic attacks
.
Statins have opened a new prelude to secondary stroke prevention, heralding the real arrival of the "statin era" in neurology
.
■Clinical studies of atorvastatin [1], compared with the dose of 10mg/d, 20mg/d of atorvastatin in the treatment of acute ischemic stroke patients can be more effective in lowering lipids and anti-inflammatory, thereby Stabilize atherosclerotic plaque, restore nervous system damage, improve quality of life, and have good safety
.
■Rosuvastatin The clinical efficacy and safety of Rosuvastatin in the secondary prevention of ischemic stroke have been clinically verified
.
In patients with ischemic stroke and hyperlipidemia, taking atorvastatin as the control, it has been proved that the effective rate of rosuvastatin is better than that of atorvastatin (P<0.
05); the adverse reaction rate is also better than that of atorvastatin Statins (P<0.
05) [2]
.
A comparative study of rosuvastatin + clopidogrel and rosuvastatin + aspirin (control group) in the prevention of ischemic stroke proved [3], the total effective rate of rosuvastatin + clopidogrel was significantly higher than that of the control group ( P<0.
05)
.
Clinical studies have found that oral administration of rosuvastatin at 20 mg/d can reduce total cholesterol and low-density cholesterol by 33.
5% and 52.
6% respectively after 12 months, which is better than simvastatin (20 mg/d) group (P<0.
05); The plaque area in the rosuvastin group was significantly less than that in the simvastatin group (P<0.
05) [4]
.
3.
Anti-platelet aggregation drug aspirin In theory, aspirin can inhibit the aggregation of platelets, thereby preventing blood clotting and preventing cerebral infarction
.
However, it is currently recognized that taking aspirin is generally not beneficial for the prevention of first stroke
.
However, in individuals with a sufficiently high risk of stroke (10-year risk of cardiovascular and cerebrovascular events is 6%-10%), aspirin can be used for cerebrovascular disease prevention; for higher-risk patients (10-year risk of cardiovascular and cerebrovascular events) >10%), the use of aspirin to prevent cerebrovascular diseases is reasonable, and its benefits far outweigh the risks [5]
.
However, it must be emphasized that long-term use of aspirin enteric-coated tablets should pay attention to the following matters: persist in taking it, morning and evening, once a day
.
Occasionally forgetting to take the medicine once can take the regular dose at the time of the next medicine, without the need to double the dose
.
Do not miss the medication continuously
.
Enteric-coated tablets should be taken orally on an empty stomach, not after meals
.
Long-term medication should monitor blood coagulation indicators
.
Choose the right dose
.
At present, it is considered that 75-300 mg/d of aspirin is a "small dose", and the best long-term dose is 75-150 mg/d.
If the dose is insufficient, the prevention purpose will not be achieved
.
150-300mg/d is mainly used in the acute phase of cerebral infarction, but its adverse reactions have also increased, and it is generally not recommended to use [5]
.
Strictly grasp the indications of "dual antibody" therapy
.
In 2014, the American Heart Association/American Stroke Association (AHA/ASA) issued the secondary prevention guidelines for stroke and transient ischemic attack.
) For patients with stroke or transient ischemic attack, aspirin plus clopidogrel 75mg/d for 90 days is reasonable.
For patients with transient ischemic attack, within 24 hours of onset, aspirin and clopidogrel can be started Dual antiplatelet therapy, continuous medication for 90 days [6]
.
4.
Adenosine Diphosphate (ADP) Receptor Antagonist Clopidogrel Clopidogrel is a second-generation ADP receptor antagonist, and is currently a commonly used platelet receptor P2Y12 inhibitor in clinical practice
.
Clopidogrel can significantly reduce the mortality and the incidence of other cardiovascular events in patients with acute coronary syndromes without revascularization
.
Compared with aspirin, clopidogrel is superior to aspirin in preventing vascular events
.
For high-risk patients, its preventive effect may be more obvious, with fewer adverse reactions
.
However, not all patients have a good response to clopidogrel, and some patients have resistance
.
Studies have suggested that [7], CYP2C19 (an important drug metabolizing enzyme) is an independent predictor of clopidogrel resistance, and CYP2C19 gene polymorphism is related to the occurrence and recurrence of ischemic stroke
.
5.
Vitamin E Vitamin E, a strong antioxidant, has been shown to reduce the prevalence of heart disease and stroke in the prevention and treatment of cardiovascular and cerebrovascular diseases, reduce the recurrence of heart disease and stroke, and reduce the mortality rate
.
At present, many elderly patients with sequelae of stroke are taking vitamin E treatment
.
However, taking vitamin E, especially large amounts, will increase the risk of bleeding (such as cerebral hemorrhage)
.
Intake of vitamin E less than or equal to 150IU/d is good for health and has no adverse reactions, while more than 150IU/d, the risk of death increases in a dose-dependent manner.
If vitamin E supplementation is equal to or more than 400IU/d, it can significantly increase the risk of death[ 8]
.
The reason is that vitamin E has anticoagulant activity, long-term high-dose use can increase the risk of hemorrhagic stroke; although low-dose vitamin E has antioxidant activity, high-dose vitamin E has become a pro-oxidant
.
Therefore, taking vitamin E should not exceed 100 mg 3 times a day
.
(Note: The conversion between milligrams and IU, the conversion values of products from different manufacturers are different due to different purity, generally 1 mg is equivalent to 1-1.
5IU)
.
References: [1] Zhang Haibo.
Discussion on the dose-effect relationship of atorvastatin in the treatment of acute ischemic stroke[J].
International Journal of Neurology and Neurosurgery, 2014, 41(4): 309-312.
[2] Dong Weihua, Xu Ning.
Efficacy and safety of rosuvastatin for secondary prevention of ischemic stroke[J].
Chinese and Foreign Medical Sciences, 2017, 36(29): 115-116+119.
[3].
Comparative observation of suvastatin+clopidogrel and rosuvastatin+aspirin in the prevention of ischemic stroke[J].
Seeking Medical Consultation (Second Half Month).
2011,9(12):302-303.
[4] Wang Xiaohong, Xu Jun, Li Li, et al.
Clinical application of CTCA in the evaluation of rosuvastatin intensified lipid-lowering reversal of coronary artery plaque[J].
Chinese Journal of Gerontology, 2015, 35: 3866-3867.
[5] Jia An .
Benefits and risks of aspirin in preventing cardiovascular and cerebrovascular diseases[J].
China Practical Medicine,2010,5(5):2:236-238[6]Li Di,Wang Wenzhi.
2014 American Heart Association/American Stroke Association Stroke Interpretation of primary prevention guidelines[J].
Chinese Journal of Neurology,2015,48(10):919-921.
[7]Qian Wenwen, Han Zhijun, Yang Chengjian.
Application of genotype-guided antiplatelet therapy in patients with coronary heart disease Research progress [J] Practical Geriatrics, 2021, 35 (5): 516-519.
[8] Wang Yingpeng.
Meta-analysis/high-dose vitamin E supplementation may increase all-cause mortality[J].
Digest of World Core Medical Journals·Heart Epidemiology, 2005, 1(6): 8.
How to use medicine to prevent stroke? October 29, 2021 is the 16th "World Stroke Day".
This year's theme is "Be aware of stroke symptoms and recognize and treat as soon as possible.
" So how should drugs be used to prevent stroke? Let's take a look with Jie Xiaoyao
.
Cerebral stroke, commonly known as "stroke", is a group of diseases that cause brain tissue damage due to sudden rupture of blood vessels in the brain or blood can not flow into the brain due to blockage of blood vessels, including ischemic and hemorrhagic strokes
.
Among them, ischemic stroke accounts for 60% to 70% of the total number of strokes
.
Due to the lack of effective treatment methods, it is currently believed that the best measure to reduce the incidence of stroke is prevention
.
The prevention of stroke is divided into primary prevention and secondary prevention
.
Primary prevention refers to the prevention before the onset of stroke, that is, through adopting various measures to correct unhealthy living habits early, and actively control the risk factors of stroke, so that healthy people can postpone the age of onset of stroke or avoid the occurrence of stroke
.
After a stroke occurs, continuing to actively treat the sequelae and control various risk factors to prevent recurrence of stroke is the basic content of secondary prevention
.
So, which drugs can be used for primary prevention? Which drugs are used for secondary prevention? How should they be administered? 1.
Angiotensin II receptor antagonist (ARB) hypertension is an important factor for stroke
.
ARB antihypertensive drugs are very important for preventing the occurrence and recurrence of stroke
.
■Valsartan Among the ARB drugs, valsartan is the drug with the most evidence-based medical evidence so far
.
In the case of the same blood pressure reduction, compared with the non-ARB drug group, the relative risk of new stroke in the valsartan group was significantly reduced
.
Evidence-based medicine evidence shows that, while lowering blood pressure, ARB can also reduce carotid artery intima-media thickness, improve insulin resistance, reduce cardiac remodeling, and reduce the occurrence and recurrence of atrial fibrillation.
It is used in preventing the occurrence and recurrence of stroke It is of great significance
.
■Losartan Recently, losartan has also been confirmed to further reduce the risk of stroke on the basis of the same lowering of blood pressure
.
Domestic experts pointed out that to strengthen the primary prevention of stroke in patients with hypertension, it is recommended to use antihypertensive treatments such as Losartan and other drugs with sufficient evidence-based evidence, conclusive efficacy and good tolerability, and strive to control blood pressure at a target level
.
2.
Statins lipid-lowering drugs Increased serum total cholesterol levels can increase the risk of ischemic stroke
.
Therefore, the prevention and treatment of dyslipidemia (mainly high cholesterol) is of great significance to the prevention of stroke
.
Statins are currently known to have the strongest cholesterol-lowering drugs, and have multidirectional effects, such as improving vascular endothelial function, inhibiting smooth muscle cell proliferation, inhibiting platelet aggregation, anti-inflammatory effects and stabilizing plaque, etc.
Help prevent stroke
.
Statins have been proven to significantly reduce the incidence of ischemic stroke and have a secondary preventive effect on ischemic stroke
.
■Simvastatin Simvastatin and other statins can reduce the risk of non-fatal and fatal strokes, including transient ischemic attacks
.
Statins have opened a new prelude to secondary stroke prevention, heralding the real arrival of the "statin era" in neurology
.
■Clinical studies of atorvastatin [1], compared with the dose of 10mg/d, 20mg/d of atorvastatin in the treatment of acute ischemic stroke patients can be more effective in lowering lipids and anti-inflammatory, thereby Stabilize atherosclerotic plaque, restore nervous system damage, improve quality of life, and have good safety
.
■Rosuvastatin The clinical efficacy and safety of Rosuvastatin in the secondary prevention of ischemic stroke have been clinically verified
.
In patients with ischemic stroke and hyperlipidemia, taking atorvastatin as the control, it has been proved that the effective rate of rosuvastatin is better than that of atorvastatin (P<0.
05); the adverse reaction rate is also better than that of atorvastatin Statins (P<0.
05) [2]
.
A comparative study of rosuvastatin + clopidogrel and rosuvastatin + aspirin (control group) in the prevention of ischemic stroke proved [3], the total effective rate of rosuvastatin + clopidogrel was significantly higher than that of the control group ( P<0.
05)
.
Clinical studies have found that oral administration of rosuvastatin at 20 mg/d can reduce total cholesterol and low-density cholesterol by 33.
5% and 52.
6% respectively after 12 months, which is better than simvastatin (20 mg/d) group (P<0.
05); The plaque area in the rosuvastin group was significantly less than that in the simvastatin group (P<0.
05) [4]
.
3.
Anti-platelet aggregation drug aspirin In theory, aspirin can inhibit the aggregation of platelets, thereby preventing blood clotting and preventing cerebral infarction
.
However, it is currently recognized that taking aspirin is generally not beneficial for the prevention of first stroke
.
However, in individuals with a sufficiently high risk of stroke (10-year risk of cardiovascular and cerebrovascular events is 6%-10%), aspirin can be used for cerebrovascular disease prevention; for higher-risk patients (10-year risk of cardiovascular and cerebrovascular events) >10%), the use of aspirin to prevent cerebrovascular diseases is reasonable, and its benefits far outweigh the risks [5]
.
However, it must be emphasized that long-term use of aspirin enteric-coated tablets should pay attention to the following matters: persist in taking it, morning and evening, once a day
.
Occasionally forgetting to take the medicine once can take the regular dose at the time of the next medicine, without the need to double the dose
.
Do not miss the medication continuously
.
Enteric-coated tablets should be taken orally on an empty stomach, not after meals
.
Long-term medication should monitor blood coagulation indicators
.
Choose the right dose
.
At present, it is considered that 75-300 mg/d of aspirin is a "small dose", and the best long-term dose is 75-150 mg/d.
If the dose is insufficient, the prevention purpose will not be achieved
.
150-300mg/d is mainly used in the acute phase of cerebral infarction, but its adverse reactions have also increased, and it is generally not recommended to use [5]
.
Strictly grasp the indications of "dual antibody" therapy
.
In 2014, the American Heart Association/American Stroke Association (AHA/ASA) issued the secondary prevention guidelines for stroke and transient ischemic attack.
) For patients with stroke or transient ischemic attack, aspirin plus clopidogrel 75mg/d for 90 days is reasonable.
For patients with transient ischemic attack, within 24 hours of onset, aspirin and clopidogrel can be started Dual antiplatelet therapy, continuous medication for 90 days [6]
.
4.
Adenosine Diphosphate (ADP) Receptor Antagonist Clopidogrel Clopidogrel is a second-generation ADP receptor antagonist, and is currently a commonly used platelet receptor P2Y12 inhibitor in clinical practice
.
Clopidogrel can significantly reduce the mortality and the incidence of other cardiovascular events in patients with acute coronary syndromes without revascularization
.
Compared with aspirin, clopidogrel is superior to aspirin in preventing vascular events
.
For high-risk patients, its preventive effect may be more obvious, with fewer adverse reactions
.
However, not all patients have a good response to clopidogrel, and some patients have resistance
.
Studies have suggested that [7], CYP2C19 (an important drug metabolizing enzyme) is an independent predictor of clopidogrel resistance, and CYP2C19 gene polymorphism is related to the occurrence and recurrence of ischemic stroke
.
5.
Vitamin E Vitamin E, a strong antioxidant, has been shown to reduce the prevalence of heart disease and stroke in the prevention and treatment of cardiovascular and cerebrovascular diseases, reduce the recurrence of heart disease and stroke, and reduce the mortality rate
.
At present, many elderly patients with sequelae of stroke are taking vitamin E treatment
.
However, taking vitamin E, especially large amounts, will increase the risk of bleeding (such as cerebral hemorrhage)
.
Intake of vitamin E less than or equal to 150IU/d is good for health and has no adverse reactions, while more than 150IU/d, the risk of death increases in a dose-dependent manner.
If vitamin E supplementation is equal to or more than 400IU/d, it can significantly increase the risk of death[ 8]
.
The reason is that vitamin E has anticoagulant activity, long-term high-dose use can increase the risk of hemorrhagic stroke; although low-dose vitamin E has antioxidant activity, high-dose vitamin E has become a pro-oxidant
.
Therefore, taking vitamin E should not exceed 100 mg 3 times a day
.
(Note: The conversion between milligrams and IU, the conversion values of products from different manufacturers are different due to different purity, generally 1 mg is equivalent to 1-1.
5IU)
.
References: [1] Zhang Haibo.
Discussion on the dose-effect relationship of atorvastatin in the treatment of acute ischemic stroke[J].
International Journal of Neurology and Neurosurgery, 2014, 41(4): 309-312.
[2] Dong Weihua, Xu Ning.
Efficacy and safety of rosuvastatin for secondary prevention of ischemic stroke[J].
Chinese and Foreign Medical Sciences, 2017, 36(29): 115-116+119.
[3].
Comparative observation of suvastatin+clopidogrel and rosuvastatin+aspirin in the prevention of ischemic stroke[J].
Seeking Medical Consultation (Second Half Month).
2011,9(12):302-303.
[4] Wang Xiaohong, Xu Jun, Li Li, et al.
Clinical application of CTCA in the evaluation of rosuvastatin intensified lipid-lowering reversal of coronary artery plaque[J].
Chinese Journal of Gerontology, 2015, 35: 3866-3867.
[5] Jia An .
Benefits and risks of aspirin in preventing cardiovascular and cerebrovascular diseases[J].
China Practical Medicine,2010,5(5):2:236-238[6]Li Di,Wang Wenzhi.
2014 American Heart Association/American Stroke Association Stroke Interpretation of primary prevention guidelines[J].
Chinese Journal of Neurology,2015,48(10):919-921.
[7]Qian Wenwen, Han Zhijun, Yang Chengjian.
Application of genotype-guided antiplatelet therapy in patients with coronary heart disease Research progress [J] Practical Geriatrics, 2021, 35 (5): 516-519.
[8] Wang Yingpeng.
Meta-analysis/high-dose vitamin E supplementation may increase all-cause mortality[J].
Digest of World Core Medical Journals·Heart Epidemiology, 2005, 1(6): 8.
