It is reasonable to avoid environmental (passive) tobacco smoke.Ĭounseling, nicotine products, and oral smoking cessation medications are effective for helping smokers to quit. Health care professionals should strongly advise every patient with stroke or TIA who has smoked in the past year to quit. Recommendations for Modifiable Behavioral Risk Factors to Prevent Recurrent Stroke Risk factor Patients with ischemic stroke or TIA with low HDL cholesterol levels may be considered for treatment with niacin or gemfibrozil (Lopid). Patients with ischemic stroke or TIA with elevated cholesterol or comorbid coronary artery disease should be otherwise managed according to NCEP–ATP III guidelines, which include lifestyle modification, dietary guidelines, and medication recommendations. Statin therapy with intensive lipid-lowering effects is recommended to reduce the risk of stroke and cardiovascular events in patients with ischemic stroke or TIA who have evidence of atherosclerosis, an LDL cholesterol level ≥ 100 mg per dL (2.59 mmol per L), and who are without known CHD.įor patients with atherosclerotic ischemic stroke or TIA and without known CHD, it is reasonable to target a reduction of at least 50 percent in LDL cholesterol levels or a target level of < 70 mg per dL (1.81 mmol per L) to obtain maximal benefit. Use of existing guidelines for glycemic control and blood pressure targets in patients with diabetes is recommended for patients who have had a stroke or TIA. The choice of specific drugs and targets should be individualized on the basis of pharmacologic properties, mechanism of action, and consideration of specific patient characteristics for which specific agents are probably indicated (e.g., extracranial cerebrovascular occlusive disease, renal impairment, cardiac disease, and diabetes). The available data indicate that diuretics or the combination of diuretics and an angiotensin-converting enzyme inhibitor are useful. The optimal drug regimen to achieve the recommended level of reduction is uncertain because direct comparisons between regimens are limited. Modifications include salt restriction weight loss consumption of a diet rich in fruits, vegetables, and low-fat dairy products regular aerobic physical activity and limited alcohol consumption. Several lifestyle modifications have been associated with blood pressure reduction and are a reasonable part of a comprehensive antihypertensive therapy. Recommendations for Treatable Vascular Risk Factors to Prevent Recurrent Stroke Risk Factorīlood pressure reduction is recommended for prevention of recurrent stroke and prevention of other vascular events in persons who have had an ischemic stroke or TIA and are beyond the first 24 hours.īecause this benefit extends to persons with and without a documented history of hypertension, this recommendation is reasonable for all patients with ischemic stroke or TIA who are considered appropriate for blood pressure reduction.Īn absolute target blood pressure level and reduction are uncertain and should be individualized, but benefit has been associated with an average reduction of approximately 10/5 mm Hg, and normal blood pressure levels have been defined as < 120/80 mm Hg by JNC7. This summary focuses on risk factors and antithrombotic therapy. The guidelines address risk factors for stroke, including treatable vascular risk factors ( Table 1) and modifiable behavioral risk factors ( Table 2) interventional approaches for patients with large-artery atherosclerosis medical treatments for patients with cardiogenic embolism and antithrombotic therapy for noncardioembolic stroke or TIA. The American Heart Association (AHA) and the American Stroke Association (ASA) have released updated guidelines on preventing recurrent stroke in patients who have had a previous stroke or TIA. The risk of stroke within 90 days of a TIA may be as high as 17 percent, with the greatest risk during the first week. In the United States, about one-fourth of the nearly 800,000 strokes that occur each year are recurrent events. Persons who survive a stroke or transient ischemic attack (TIA) are at increased risk of experiencing another stroke. Guideline source: American Heart Association/American Stroke Association