Abstract
New strategies to lower the risk of stroke among highrisk persons are being developed. Therapies such as cholesterol-lowering medications and newer antihypertensive agents appear to complement traditional antithrombotic drugs and surgical procedures. Of particular interest is the use of the newer angiotensin-converting enzyme (ACE) inhibitors, which appear to have an effect on stabilizing the vascular endothelium. The Losartan Intervention For Endpoint (LIFE) reduction in hypertension study provides additional data to support the use of the ACE inhibitors to lower the risk of stroke among patients with hypertension and vascular diseases.
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References and Recommended Reading
Antithrombotic Trialist’s Collaboration: Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002, 324:71–86.
Blauw GJ, Lagaay AM, Smelt AH, Westendorp RG: Stroke, statins, and cholesterol. Stroke 1997, 28:946–950.
Byington RP, Jukema JW, Salonen JT, et al.: Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the Pravastatin Atherosclerosis Intervention Program. Circulation 1995, 922:2419–2425.
Hebert PR, Gaziano JM, Chan KS, Hennekens CH: Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials. JAMA 1997, 278:313–321.
Crouse JR, Byington RP, Furberg CD: HMG-CoA reductase inhibitor therapy and stroke risk reduction: an analysis of clinical trials data. Atherosclerosis 1998, 138:11–24.
Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.
PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure lowering regimen among 6,105 individuals with previous stroke or transient ischemic attack. Lancet 2001, 358:1026–1027.
Neal B, MacMahon S, Chapman N: Blood Pressure Lowering Treatment Trialist’s Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 2000, 356:1955–1964.
Dahlöf B, Devereux RB, Kjeldsen SE, et al., for the LIFE Study Group: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:995–1003. Important study.
Lindholm LH, Ibsen H, Dahlöf B, et al., for the LIFE Study Group: Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:1004–1010. Important study.
Sacco RL: Risk factors and outcomes for ischemic stroke. Neurology 1995, 45:S10-S14.
Lindenstrom E, Boysen G, Nyboe J: Influence of systolic and diastolic blood pressure on stroke risk: a prospective observational study. Am J Epidemiol 1995, 142:1279–1290.
MacMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1992, 335:765–774.
Phillips SJ, Whisnant JP: Hypertension and the brain. The National High Blood Pressure Education Program. Arch Intern Med 1992, 152:938–945.
Staessen JA, Thijs L, Gasowski J, Cells H, Fagard RH: Treatment of isolated systolic hypertension in the elderly: further evidence from the systolic hypertension in TEurope (Syst-Eur) trial. Am J Cardiol 1998, 82:20R-22R.
Hansson L: The Hypertension Optimal Treatment Study and the importance of lowering blood pressure. J Hypertens 1999, 17(suppl):S9–13.
Kannel WB: Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996, 275:1571–1576.
Klungel OH, Stricker BH, Paes AH, et al.: Excess stroke among hypertensive men and women attributable to undertreatment of hypertension. Stroke 1999, 30:1312–1318.
Hansson L, Hedner T, Lund-Johansen P, et al.: Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359–365.
Dzau VJ, Bernstein K, Celermajer D, et al., for the Working Group on Tissue Angiotensin-converting enzyme, International Society of Cardiovascular Pharmacotherapy: The relevance of tissue angiotensin-converting enzyme: manifestations in mechanistic and endpoint data. Am J Cardiol 2001, 88:1L-20L.
Bakris GL: Angiotensin-converting enzyme inhibition to enhance vascular health-clinical and research models. Am J Hypertens 2002, 14:264S-269S.
Islim IF, Bareford D, Beevers DG: A single (investigator)-blind randomised control trial comparing the effects of quinapril and mifedipine on platelet function in patients with mild to moderate hypertension. Platelets 2001, 12:274–278.
Calles-Escandon J, Cipolla M: Diabetes and endothelial dysfunction: a clinical perspective. Endocrine Rev 2001, 22:36–52.
Myers BD, Boothroyd D, Olshen RA: Angiotensin-converting enzyme inhibitor for slowing progression of diabetic and nondiabetic kidney disease. J Am Soc Nephrol 1998, 9:S66-S70.
Borghi C, Ambrosioni E: Evidence-based medicine and ACE inhibition. J Cardiovasc Pharmacol 1998, 32:S24-S35.
Lazar HL, Bao Y, Rivers S, Colton T, Bernard SA: High tissue affinity angiotensin-converting enzyme inhibitors improve endothelial function and reduce infarct size. Ann Thoracic Surg 2001, 72:548–553.
Taddei S, Virdis A, Ghiadoni L, Mattei P, Salvetti A: Effects of angiotensin converting enzyme inhibition on endotheliumdependent vasodilatation in essential hypertensive patients. J Hypertens 1998, 16:447–456.
Enseleit F, Hurlimann D, Luscher TF: Vascular protective effects of angiotensin converting enzyme inhibitors and their relation to clinical events. J Cardiovasc Pharmacol 2001, 37:S21-S30.
Niskanen L, Hedner T, Hansson L, Lanke J, Niklason A, for the The CAPPP Study Group. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/ beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001, 24:2091–2096.
Gorelick PB: Stroke prevention therapy beyond antithrombotics. Unifying mechanisms in ischemic stroke pathogenesis and implications for therapy. Stroke 2002, 33:862–875.
Alberts MJ: Secondary prevention of stroke and the expanding role of the neurologist. Cerebrovasc Dis 2002, 13(suppl 1):12–16.
Hess DC, Demchuk AM, Brass LM, Yatsu FM: HMG-CoA reductase inhibitors (statins). A promising approach to stroke prevention. Neurology 2000, 54:790–796.
Pyorala M, Miettinen H, Halonen P, Laakso M, Pyorala K: Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22-year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000, 20:538–544.
Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP: Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. Am J Epidemiol 2000, 152:897–907.
Pihlajamaki J, Austin M, Edwards K, Laakso M: A major gene effect on fasting insulin and insulin sensitivity in familial combined hyperlipidemia. Diabetes 2001, 50:2396–2401.
Hevener AL, Reichart D, Janez A, Olefsky J: Thiazolidinedione treatment prevents free fatty acid-induced insulin resistance in male wistar rats. Diabetes 2001, 50:2316–2322.
Smith U: Pioglitazone: mechanism of action. Int J Clin Pract 2001, 121(suppl):13–18.
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Adams, H.P. New strategies for prevention of ischemic stroke: The life study. Curr Neurol Neurosci Rep 3, 46–51 (2003). https://doi.org/10.1007/s11910-003-0036-7
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DOI: https://doi.org/10.1007/s11910-003-0036-7