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Perspectives and Approach to Stroke Prevention and Therapy

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Book cover Handbook of Clinical Nutrition and Stroke

Part of the book series: Nutrition and Health ((NH))

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Key Points

  • Stroke is the second leading cause of death globally and in countries with high or middle income. Worldwide, 15 million strokes happen annually and they account for around 5.5 million deaths or nearly 10 % of all deaths per year.

  • The prevalence of stroke is expected to increase in the future as the aging population continues to grow.

  • The WHO developed a stepwise approach to stroke surveillance (STEPS-stroke) in order to collect epidemiologic data on stroke worldwide and improvise better preventive measures in disadvantaged societies.

  • A stroke is a vascular accident of the central nervous system that leads to sudden death of brain cells due to inadequate blood flow. It is a heterogeneous disease that can be divided into two broad categories: ischemic and hemorrhagic strokes.

  • Age, sex, race, and heredity are non-modifiable risk factors for stroke. However, the following risk factors (hypertension, atrial fibrillation, diabetes mellitus, dyslipidemia, carotid artery disease, smoking, alcoholism, physical inactivity, obesity, drug abuse) are among the modifiable ones.

  • Age is the single most important risk factor for strokes, and hypertension is the most important modifiable one.

  • The role of antiplatelet agents like aspirin, clopidogrel, and dipyridamole in primary stroke prevention has not been well defined yet, but in terms of secondary prevention, they seem to be moderately effective in preventing recurrent strokes.

  • Recombinant tissue plasminogen activator (r-tPA) is currently the mainstay therapy for acute ischemic strokes. If administered in the first 4.5 h after stroke onset, it may result in 30 % more likelihood of patients having minimal or no disability at 3 months after the stroke.

  • For large artery occlusion strokes, the American Heart Association recommends using intra-arterial fibrinolytic therapy in the first 3–6 h window after stroke as an alternative to intravenous therapy.

  • Recent advances in the interventional management of acute strokes led to the development of new ways to mechanically disrupt blood clots or retrieve them from the arteries.

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Abbreviations

ACAS:

Asymptomatic Carotid Atherosclerosis Study

CRP:

C-Reactive Protein

DALYs:

Disability-Adjusted Life Years)

HTN:

Hypertension

LDL-C:

Low-Density Lipoprotein Cholesterol

r-tPA:

Recombinant Tissue Plasminogen Activator

STEPS:

Stepwise Approach to Stroke Surveillance

TIAs:

Transient Ischemic Attacks

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Authors and Affiliations

  1. Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Hanna House Room Number: 512, Cleveland, OH, USA

    Bassel Raad M.D. & Michael De Georgia M.D.

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  1. Bassel Raad M.D.
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  2. Michael De Georgia M.D.
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Correspondence to Bassel Raad M.D. .

Editor information

Editors and Affiliations

  1. , Nutrition Support Team, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, Ohio, USA

    Mandy L. Corrigan

  2. , Nutrition Therapy, Cleveland Clinic, 9500 Euclid Ave. M17, Cleveland, 44195, Ohio, USA

    Arlene A. Escuro

  3. Center for Human Nutrition, Department of Gastroenterology, Cleveland Clinic, 9500 Euclid Ave. A51, Cleveland, 44195, Ohio, USA

    Donald F. Kirby

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Raad, B., De Georgia, M. (2013). Perspectives and Approach to Stroke Prevention and Therapy. In: Corrigan, M., Escuro, A., Kirby, D. (eds) Handbook of Clinical Nutrition and Stroke. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-380-0_4

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  • DOI: https://doi.org/10.1007/978-1-62703-380-0_4

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