Stroke, Vol. 37, No. 2. (1 February 2006), pp. 577-617.
The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations. (Stroke. 2006;37:577-617.)
Ralph Sacco, Robert Adams, Greg Albers, Mark Alberts, Oscar Benavente, Karen Furie, Larry Goldstein, Philip Gorelick, Jonathan Halperin, Robert Harbaugh, Claiborne Johnston, Irene Katzan, Margaret Kelly-Hayes, Edgar Kenton, Michael Marks, Lee Schwamm, Thomas Tomsick
Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack
Stroke, Syndicated
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Jul 272009
Stroke, Vol. 37, No. 2. (1 February 2006), pp. 577-617.Relative and Cumulative Effects of Lipid and Blood Pressure Control in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial
Stroke, Syndicated
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Jul 182009
Stroke, Vol. 40, No. 7. (1 July 2009), pp. 2486-2492.
Background and Purpose-- The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events in patients with stroke is not well defined. Methods-- We randomized 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease to atorvastatin 80 mg per day or placebo. Results-- After 4.9 years, at each level of LDL-C reduction, subjects with HDL-C value above the median or systolic BP below the median had greater reductions in stroke and major cardiovascular events and those with a reduction in triglycerides above the median or diastolic BP below the median showed similar trends. There were no statistical interactions between on-treatment LDL-C, HDL-C, triglycerides, and BP values. In a further exploratory analysis, optimal control was defined as LDL-C <70 mg per deciliter, HDL-C >50 mg per deciliter, triglycerides <150 mg per deciliter, and SBP/DBP <120/80 mm Hg. The risk of stroke decreased with as the level of control increased (hazard ratio [95% confidence interval] 0.98 [0.76 to 1.27], 0.78 [0.61 to 0.99], 0.62 [0.46 to 0.84], and 0.35 [0.13 to 0.96]) for those achieving optimal control of 1, 2, 3, or 4 factors as compared to none, respectively. Results were similar for major cardiovascular events. Conclusions-- We found a cumulative effect of achieving optimal levels of LDL-C, HDL-C, triglycerides, and BP on the risk of recurrent stroke and major cardiovascular events. The protective effect of having a higher HDL-C was maintained at low levels of LDL-C. 10.1161/STROKEAHA.108.546135
Pierre Amarenco, Larry Goldstein, Michael Messig, Blair O'Neill, Alfred Callahan, Henrik Sillesen, Michael Hennerici, Justin Zivin, KMA Welch
Background and Purpose-- The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events in patients with stroke is not well defined. Methods-- We randomized 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease to atorvastatin 80 mg per day or placebo. Results-- After 4.9 years, at each level of LDL-C reduction, subjects with HDL-C value above the median or systolic BP below the median had greater reductions in stroke and major cardiovascular events and those with a reduction in triglycerides above the median or diastolic BP below the median showed similar trends. There were no statistical interactions between on-treatment LDL-C, HDL-C, triglycerides, and BP values. In a further exploratory analysis, optimal control was defined as LDL-C <70 mg per deciliter, HDL-C >50 mg per deciliter, triglycerides <150 mg per deciliter, and SBP/DBP <120/80 mm Hg. The risk of stroke decreased with as the level of control increased (hazard ratio [95% confidence interval] 0.98 [0.76 to 1.27], 0.78 [0.61 to 0.99], 0.62 [0.46 to 0.84], and 0.35 [0.13 to 0.96]) for those achieving optimal control of 1, 2, 3, or 4 factors as compared to none, respectively. Results were similar for major cardiovascular events. Conclusions-- We found a cumulative effect of achieving optimal levels of LDL-C, HDL-C, triglycerides, and BP on the risk of recurrent stroke and major cardiovascular events. The protective effect of having a higher HDL-C was maintained at low levels of LDL-C. 10.1161/STROKEAHA.108.546135
Pierre Amarenco, Larry Goldstein, Michael Messig, Blair O'Neill, Alfred Callahan, Henrik Sillesen, Michael Hennerici, Justin Zivin, KMA Welch
Genetic testing oversight
Medicaid News, Syndicated
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Jul 162009
Science (New York, NY), Vol. 313, No. 5795. (29 September 2006), 1853.
KL Hudson
KL Hudson
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