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    Home > Active Ingredient News > Study of Nervous System > The primary prevention of ischemic stroke starts from these two aspects!

    The primary prevention of ischemic stroke starts from these two aspects!

    • Last Update: 2021-10-21
    • Source: Internet
    • Author: User
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    Ischemic stroke is the most common subtype of stroke, and its morbidity, mortality, and disability rate are relatively high.
    The active participation of primary general practitioners in comprehensive prevention and treatment is one of the key measures to control ischemic stroke
    .

    "Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (Practical Edition 2021)" introduces the definition, classification, epidemiological trends, etiology, identification, diagnosis, treatment, referral and primary management of ischemic stroke
    .

    Regarding the primary prevention of ischemic stroke, let's take a look at what the guide says! 01 Improve life>
    .

    (2) Diet and nutrition: diversify the daily diet, adopt a balanced diet including fruits, vegetables, low-fat dairy products, and low total fat and saturated fat content; recommended salt intake ≤ 6 g/d, potassium Intake ≥4.
    7 g/d
    .

    (3) Smoking: Quit smoking, avoid active and passive smoking
    .

    (4) Physical activity: Choose suitable physical activity to reduce the risk of ischemic stroke
    .

    Healthy adults should have aerobic physical activities (such as brisk walking, jogging, biking, etc.
    ) at least 3 to 4 times a week, with a duration of at least 40 minutes each time of moderate or moderate intensity
    .

    But for sedentary people, even a few minutes of physical activity is beneficial
    .

    (5) Drinking: It is not recommended to use a small amount of alcohol to prevent ischemic stroke; drinkers should give up alcohol
    .

    02 Control risk factors/causes (1) Hypertension: Strengthen blood pressure monitoring and management.
    Patients with ordinary hypertension should reduce their blood pressure to <140/90 mmHg (1 mmHg=0.
    133 kPa); with heart failure, myocardial infarction, diabetes or kidney disease According to the risk stratification and tolerance of hypertensive patients, it can be further reduced
    .

    The blood pressure of the elderly (≥65 years old) can be reduced to <150/90 mmHg according to the specific situation; but if it can be tolerated (without dizziness and other symptoms of cerebral hypoperfusion), it should be further reduced
    .

    Achieving blood pressure is the key, so all kinds of antihypertensive drugs can be recommended
    .

    You can refer to the "Guidelines for Primary Diagnosis, Treatment and Treatment of Hypertension (2019)"
    .

    (2) Atrial fibrillation: In principle, patients with non-valvular atrial fibrillation, such as those with CHA2DS2‑VASc score ≥2 points for men and ≥3 points for women, and a low risk of bleeding complications (HAS‑BLED score ≤3 points) are recommended.
    For long-term oral warfarin anticoagulation therapy, the target value of the international normalized ratio (INR) ranges from 2.
    0 to 3.
    0
    .

    Under conditions, new oral anticoagulants can also be selected, such as dabigatran, rivaroxaban, apixaban, edoxaban and so on
    .

    For patients with atrial fibrillation who are not suitable for long-term anticoagulation therapy, left atrial appendage occlusion, radiofrequency ablation, etc.
    can be considered in qualified medical institutions
    .

    Refer to the "Guidelines for Primary Diagnosis, Treatment and Treatment of Atrial Fibrillation (2019)"
    .

    (3) Other heart diseases: In addition to atrial fibrillation, other types of heart diseases may also increase the risk of ischemic stroke
    .

    Adults should have regular physical examinations to detect heart disease early
    .

    (4) Dyslipidemia: regardless of the baseline low-density lipoprotein cholesterol (LDL‑C) level, patients with ischemic stroke are encouraged to adopt modified life>
    .

    The LDL‑C target value is set according to the risk of atherosclerotic cardiovascular disease (ASCVD): very high risk LDL‑C<1.
    8 mmol/L (70 mg/dl), high risk LDL‑C<2.
    6 mmol/L ( 100 mg/dl); LDL‑C who is difficult to reach the standard can consider subcutaneous injection of proprotein convertase subtilisin Kexin9 (PCSK9) inhibitor
    .

    For patients unable to tolerate statins can be considered non-lipid-lowering statin therapy, e.
    g.
    fibrates, ezetimibe, nicotinic acid and the like
    .

    Refer to the "Guidelines for Primary Diagnosis and Treatment of Dyslipidemia (2019)"
    .

    (5) Diabetes: Diabetic patients should improve their life>
    .

    Those who are still unsatisfied with blood sugar control for 2 to 3 months should be treated with oral hypoglycemic drugs or insulin
    .

    Blood glucose standards: fasting blood glucose 4.
    4~7.
    0 mmol/L, postprandial blood glucose 4.
    4~<10.
    0 mmol/L, glycosylated hemoglobin reduced to <7%
    .

    You can refer to "Guidelines for Type 2 Diabetes Primary Diagnosis and Treatment (Practical Edition·2019)"
    .

    (6) Asymptomatic carotid artery stenosis: Patients with asymptomatic carotid artery stenosis can consider taking aspirin and statins daily according to their tolerance (liver and kidney function and muscle enzyme changes), while screening for other treatable vascular diseases Risk factors, reasonable treatment; when the stenosis is ≥70%, after a sufficient cerebral blood perfusion assessment, if it is confirmed that the cerebral blood perfusion is insufficient, it can be in a hospital with conditions (perioperative stroke and mortality < Carotid endarterectomy (CEA) or carotid artery stenting (CAS) is performed in 3% of hospitals; for patients with asymptomatic carotid artery stenosis >50%~<70%, it is recommended to perform regular carotid artery stenosis in qualified hospitals Follow-up ultrasound to monitor the progress of the disease
    .

    (7) Overweight and obesity: People who are overweight and obese can reduce their weight through improved life>
    .

    Body mass index (BMI) is controlled at 18.
    5~<24.
    0 kg/m^2; waist circumference is controlled at <85 cm for men and <80 cm for women
    .

    You can refer to the "Guidelines for Primary Diagnosis and Treatment of Obesity (2019)"
    .

    The above content is extracted from: Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, etc.
    Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (Practical Edition·2021)[J] .
    Chinese Journal of General Practitioners, 2021, 20 (9): 947-958.
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